Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative

• DOI: 10.1371/journal.pone.0279968
• Publication Date: 2023-01-05T18:52:59Z
• Authors: Alfred Jerrod Anz...; Jing Sun; Amanda J. Vinson; William H. Beasley; William B. Hillegass; Kimberly Murray; Brian M. Hendricks; Melissa Haendel; Carol Reynolds Geary; Kristina L. Bailey; Corrine K. Hanson; Lucio Miele; Ronald Horswell; Julie A. McMurry; J. Zachary Porter...; Michael T. Vest; H. Timothy Bunnell; Jeremy R. Harper; Bradley S. Price; Susan L. Santangelo; Clifford J. Rosen; James C. McClay; Sally L. Hodder
• Keywords: Rurality

Background While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. Methods conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier Cox-Proportional Hazards models adjusted demographic differences comorbid conditions, we assessed impact rurality, county vaccine hesitancy, vaccination rates on BTI over 180 days following two mRNA vaccinations September 21, 2021. Additionally, Cox Proportional without documented vaccinations. secondarily odds hospitalization events based status using multivariable logistic regression during period. Results Our population included 566,128 1,724,546 vaccination. Among persons, rurality was associated with an increased (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42–1.64, urban-adjacent rural 1.65, 1.42–1.91, nonurban-adjacent rural) compared urban dwellers. Compared low vaccine-hesitant counties, higher risks were medium (1.07, 1.02–1.12) high (1.33, 1.23–1.43) counties. counties rates, dwelling in (1.34, 1.27–1.43) but not (1.00, 0.95–1.07). Community also Vaccinated period had significantly lower across all geographic areas exposures. Conclusions findings suggest that are BTI, particularly hesitancy. Communities, such as those disproportionately hesitant areas, certain groups at events, including immunosuppressed/compromised should continue receive public health focus, targeted interventions, consistent guidance help manage spread protection wanes.