Background Communities of color are disproportionately impacted by COVID-19 and systemic lupus erythematosus (SLE). We explored factors associated with vaccine hesitancy (VH) in a SLE cohort.

Methods The Georgians Organized Against Lupus Cohort is a population-based cohort of adult, validated lupus patients in Atlanta, Georgia. Participants were surveyed by internet, mail, phone or in person beginning in April 2020 covering sociodemographics, medications, and psychosocial factors. An additional survey beginning January 2021 assessed vaccination perceptions. Frequency of responses through June 2021 were reported overall and by vaccine hesitancy status. Differences were evaluated using t-tests and P-values. Multivariate logistic regression analyses were conducted to explore factors associated with VH.

Results Excluding those with severe reactions to previous vaccinations (n=71), religious exemptions (n=33), or diagnoses of primary cutaneous lupus (n=74), 598 individuals (details in table 1) with SLE were predominantly female (93.3%) and Black (78.4%) with a mean age at survey of 51.4 years. Many lived in poverty (25.5%), were unemployed (35.6%), and had Medicare and/or Medicaid (51.6%). Those endorsing VH (42.1%) were younger, more often Black, less married, poorer, less educated, and had more Medicare and/or Medicaid compared to those who were vaccine receptive (57.9%). They were significantly younger at diagnosis but with shorter disease duration. There were no differences in disease activity, damage, or medication use, except for more glucocorticoid use in the VH group. The VH group had less trust in the government, news, doctors, and lupus advocacy or support groups and less general concern for COVID-19. Their vaccination attitudes were strongly towards mistrust, concern about unseen effects, and natural immunity. Their vaccine beliefs favored more lupus-related side effects, more potential to flare lupus, and decreased efficacy in lupus. They also had fewer flu vaccinations in previous seasons, less resilience, and higher depression but no differences in healthcare or everyday discrimination. Multivariable logistic regression showed higher odds of VH in younger, less educated, Black, and depressed participants (table 2).

Conclusions Very high levels (42.1%) of VH persist in a predominantly Black SLE population. Despite lower vaccine uptake, 66.1% with COVID-19 VH had a recent flu vaccine, indicating potential vaccine receptivity. With less trust in the government, news, doctors, and lupus groups, community leaders and peers should lead outreach. Focus should include those who are younger, Black, and from lower socioeconomic groups, particularly with depression.