Delayed access to COVID-19 vaccination among migrants in Spain during 2021: an electronic health records-based study.

BACKGROUND: In Spain, COVID-19 vaccination started on 27 December 2020, prioritizing people in long-term care facilities (LTCF), the elderly, and healthcare and essential workers. Different barriers to vaccination might have decreased or delayed uptake for migrant populations. We assessed the time to first COVID-19 vaccination by country of birth. METHODS: We studied ≥12-year-olds registered within the Spanish healthcare administrative database between 27 December 2020 and 31 December 2021, not living in LTCF, with information on country of birth, and at least one COVID-19 vaccine dose. Using Weibull parametric survival models, we compared time to first vaccination between Spanish-born individuals and those born in: Western countries (WC), Eastern Europe (EE), North Africa and the Middle East (NAME), Sub-Saharan Africa (SSA), South-East Asia (SEA), Central America and the Caribbean (CAC), or South America (SA); adjusting for sex, age, priority vaccination group and region. RESULTS: We included 26,720,450 individuals (Spanish-born: 86.1%; WC: 3.5%; EE: 0.4%; SSA: 0.6%; NAME: 2.1%; SEA: 0.6%; CAC: 1.4%; SA: 5.3%). Hazard Ratio for first vaccination was lower for all migrants' groups, WC: 0.68, EE: 0.45, SSA: 0.49, NAME: 0.56, SEA: 0.64, CAC: 0.65 and SA: 0.74, and median time to vaccination (days) was higher, WC: 164, EE: 185, SSA: 181, NAME: 174, SEA: 167, CAC: 166 and SA: 160, compared to 147 in Spanish-born. CONCLUSIONS: Migrants of any origin living in Spain accessed COVID-19 vaccination later than Spanish-born individuals. These findings highlight existing barriers increasing migrants' vulnerability during the pandemic and call for additional efforts to ensure equitable access.