Uptake and Factors Associated With COVID-19 Vaccination Among 3,779,733 Adults Living With and Without Diabetes: A Population Cohort Study in a Universal Health-care Setting

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OBJECTIVES: Our aim in this study was to assess COVID-19 vaccine uptake among adults with and without diabetes and the factors associated with vaccination in people with diabetes. METHODS: This retrospective, population-based cohort study included all adults living in Alberta, Canada, on December 14, 2020, the date COVID-19 vaccines became available. Individual diabetes status was determined between April 1, 2002 and December 14, 2020, using a validated algorithm. Individuals were followed until March 31, 2022. The primary outcome was full vaccination, as defined by the manufacturer. Descriptive statistics were used to compare vaccination status among people with and without diabetes. Unadjusted and multivariable-adjusted Cox proportional hazards models were applied to assess factors associated with full vaccination uptake. RESULTS: Among the 3,779,733 adults (49.7% women; mean age 47.2±18.2 years) included in the study, 9.8% had diabetes. A higher proportion of people with diabetes, compared to those without diabetes, were fully vaccinated (82.5% vs 73.1%, p<0.001; men: adjusted hazard ratio [aHR] 1.34, 95% confidence interval [CI] 1.33 to 1.35; women: aHR 1.23, 95% CI 1.22 to 1.24). In people with diabetes, being 65 to 74 years old (men: aHR 1.21, 95% CI 1.16 to 1.26; women: aHR 1.22, 95% CI 1.16 to 1.27) and statin use (men: aHR 1.28, 95% CI 1.27 to 1.30; women: aHR 1.24, 95% CI 1.22 to 1.26) were associated with full vaccination, whereas lower socioeconomic status (men: aHR 0.82, 95% CI 0.81 to 0.84 for quintile 5; women: aHR 0.80, 95% CI 0.79 to 0.82 for quintile 5), rural residence (men: aHR 0.86, 95% CI 0.85 to 0.87; women: aHR 0.87, 95% CI 0.85 to 0.92), higher number of comorbidities (men: aHR 0.95, 95% CI 0.94 to 0.96; women: aHR 0.98, 95% CI 0.97 to 0.99), higher glycated hemoglobin level (men: aHR 0.44, 95% CI 0.43 to 0.45; women: aHR 0.50, 95% CI 0.49 to 0.51), and insulin use (men: aHR 0.89, 95% CI 0.87 to 0.91; women: aHR 0.89, 95% CI 0.87 to 0.91) were associated with lower vaccination uptake. CONCLUSIONS: People with diabetes had high COVID-19 vaccination uptake. Further work is needed to better understand the system- and individual-based facilitators of, and barriers to, vaccine uptake to inform future public health vaccine-based interventions.

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