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. 2021 Aug 26;18:E83. doi: 10.5888/pcd18.210143

Disparities in Internet Access and COVID-19 Vaccination in New York City

Isaac H Michaels 1,, Sylvia J Pirani 2, Alvaro Carrascal 1
PMCID: PMC8462290  PMID: 34436987

A bivariate choropleth map that visualizes zip code–level data on household internet access and COVID-19 vaccination in New York City. The map identifies zip codes where the greatest disparities exist. Most disparities are in the Bronx and Brooklyn. This information could be used to place appointment-free vaccination sites in the short term and augment digital education and broadband internet access in the long term. Data on internet access were retrieved from NYC Open Data on April 7, 2021. Vaccination data were retrieved from the New York City Department of Health and Mental Hygiene on April 7, 2021.

Modified Zip Code Tabulation Area Percentage of Households Without Internet Access Percentage of Adults With ≥1 COVID-19 Vaccine Dose Neighborhood
10001 9.1 44.9 Chelsea/NoMad/West Chelsea
10002 30.9 47.6 Chinatown/Lower East Side
10003 8.0 44.7 East Village/Gramercy/Greenwich Village
10004 0.8 64.9 Financial District
10005 1.2 42.6 Financial District
10006 1.4 47.2 Financial District
10007 9.3 62.2 TriBeCa
10009 17.2 44.5 Alphabet City/East Village/Stuyvesant Town-Cooper Village
10010 8.4 46.8 Flatiron/Gramercy/Kips Bay
10011 5.9 52.5 Chelsea
10012 11.2 45.2 Greenwich Village/SoHo
10013 15.5 52.2 Hudson Square/Little Italy/SoHo/TriBeCa
10014 6.1 50.1 Hudson Square/Meatpacking District/West Village
10016 7.7 51.7 Kips Bay/Murray Hill/NoMad
10017 3.9 53.1 East Midtown/Murray Hill
10018 5.6 33.3 Hell's Kitchen/Midtown Manhattan
10019 9.0 49.5 Hell's Kitchen/Midtown Manhattan
10021 5.8 58.0 Lenox Hill/Upper East Side
10022 7.0 59.9 East Midtown
10023 6.6 56.3 Lincoln Square
10024 7.2 57.5 Upper West Side
10025 11.5 51.7 Manhattan Valley/Morningside Heights/Upper West Side
10026 18.3 34.5 Central Harlem (South)
10027 19.6 34.0 Central Harlem (South)/Morningside Heights/West Harlem
10028 4.6 53.8 Upper East Side/Yorkville
10029 22.1 36.1 East Harlem
10030 18.4 28.5 Central Harlem (North)
10031 18.1 35.0 Hamilton Heights/West Harlem
10032 20.5 38.3 Washington Heights (South)
10033 17.0 35.8 Washington Heights (North)/Washington Heights (South)
10034 16.9 34.5 Inwood/Washington Heights (North)
10035 27.8 39.2 East Harlem
10036 11.4 50.3 Hell's Kitchen/Midtown Manhattan
10037 20.8 32.8 Central Harlem (North)/East Harlem
10038 16.7 42.1 Chinatown/Financial District
10039 18.0 27.9 Central Harlem (North)/Washington Heights (South)
10040 15.6 37.2 Washington Heights (North)
10044 7.7 47.3 Roosevelt Island
10065 6.9 60.1 Lenox Hill/Upper East Side
10069 3.9 53.3 Lincoln Square
10075 7.1 66.2 Lenox Hill/Upper East Side
10128 9.9 55.9 Upper East Side/Yorkville
10280 1.0 44.9 Battery Park City
10282 0.0 44.3 Battery Park City
10301 19.0 40.9 Silver Lake/St. George
10302 19.2 33.5 Elm Park
10303 20.8 31.8 Graniteville/Mariner's Harbor/Port Ivory
10304 22.5 39.9 New Dorp/Todt Hill
10305 16.9 40.7 Arrochar/Midland Beach/Shore Acres/South Beach Ocean Breeze
10306 14.9 44.5 Lighthouse Hill/Midland Beach/New Dorp/Oakwood
10307 12.2 36.0 Tottenville
10308 10.6 38.7 Great Kills
10309 10.8 38.2 Charleston/Prince's Bay/Woodrow
10310 23.4 42.1 Port Richmond/Randall Manor/West Brighton
10312 10.7 41.8 Annadale/Rossville
10314 11.7 40.6 Bloomfield/Freshkills Park
10451 27.6 34.9 Concourse/Melrose
10452 26.2 31.8 Concourse/Highbridge
10453 26.2 28.0 Morris Heights/Mount Hope/University Heights
10454 32.4 28.2 Mott Haven/Port Morris
10455 28.2 29.3 Mott Haven
10456 26.0 28.0 Claremont/Morrisania
10457 26.8 27.8 Belmont/Claremont/Mount Hope/Tremont
10458 20.9 26.9 Belmont/Fordham University/Kingsbridge
10459 28.1 29.6 Charlotte Gardens/Hunts Point
10460 28.5 27.6 Charlotte Gardens/Tremont/Van Nest/West Farms
10461 17.6 43.1 Morris Park/Pelham Bay/Westchester Square
10462 17.6 37.8 Parkchester/Pelham Parkway/Van Nest/Westchester Square
10463 15.6 43.6 Kingsbridge/Marble Hill/Riverdale/Spuyten Duyvil
10464 24.1 54.8 City Island
10465 15.2 38.8 Country Club/Throgs Neck
10466 19.3 25.7 Edenwald/Wakefield
10467 20.6 29.3 Allerton/Norwood/Pelham Parkway/Williamsbridge
10468 20.0 28.9 Fordham/Kingsbridge/University Heights
10469 19.0 31.2 Allerton/Baychester/Pelham Gardens/Williamsbridge
10470 17.7 34.1 Wakefield/Woodlawn
10471 13.8 51.1 Fieldston/North Riverdale/Riverdale
10472 24.3 28.4 Soundview
10473 20.4 32.3 Castle Hill/Clason Point/Soundview
10474 28.3 23.4 Hunts Point
10475 21.0 40.9 Co-op City/Edenwald
11004 12.5 43.4 Bellerose/Douglaston-Little Neck
11101 12.1 50.8 Astoria (South)/Long Island City/Sunnyside
11102 12.2 46.9 Astoria (North)
11103 13.2 40.3 Astoria (North)/Astoria (South)
11104 14.1 46.6 Sunnyside
11105 13.2 38.2 Ditmars Steinway
11106 13.9 43.9 Astoria (South)
11109 2.1 50.8 Long Island City
11201 9.6 53.1 Brooklyn Heights/DUMBO/Downtown Brooklyn
11203 21.5 27.8 East Flatbush (North)/East Flatbush (South)
11204 24.9 31.8 Bensonhurst/Mapleton
11205 21.8 31.3 Bedford-Stuyvesant (West)/Clinton Hill/Fort Greene
11206 26.8 30.0 Williamsburg (South)
11207 22.0 24.5 Cypress Hills/East New York
11208 19.2 25.2 Cypress Hills/East New York
11209 12.8 42.3 Bay Ridge/Fort Hamilton
11210 14.0 25.6 Flatlands/Midwood
11211 26.7 35.6 East Williamsburg/Williamsburg (North)/Williamsburg (South)
11212 27.0 24.5 Ocean Hill-Brownsville
11213 23.1 25.3 Crown Heights (East)
11214 17.0 33.7 Bath Beach/Bensonhurst/Gravesend
11215 6.8 50.5 Gowanus/Park Slope/Windsor Terrace
11216 17.8 37.7 Bedford-Stuyvesant (West)/Crown Heights (West)
11217 7.9 45.4 Boerum Hill/Park Slope
11218 18.7 37.8 Kensington/Windsor Terrace
11219 31.9 25.1 Borough Park
11220 22.2 36.4 Sunset Park
11221 21.5 31.9 Bedford-Stuyvesant (East)/Bushwick
11222 13.7 44.8 Greenpoint
11223 17.2 29.1 Gravesend/Homecrest
11224 26.5 27.6 Brighton Beach/Coney Island/Seagate
11225 20.4 33.3 Crown Heights (West)/Prospect Lefferts Gardens
11226 22.4 30.2 Flatbush/Prospect Lefferts Gardens
11228 13.9 38.2 Bath Beach/Dyker Heights
11229 15.2 32.7 Gerritsen Beach/Homecrest/Sheepshead Bay
11230 20.3 27.7 Midwood
11231 12.6 43.5 Carroll Gardens/Cobble Hill/Red Hook
11232 17.1 33.4 Sunset Park
11233 24.8 24.4 Bedford-Stuyvesant (East)/Ocean Hill-Brownsville
11234 13.8 30.8 Bergen Beach/Flatlands/Marine Park/Mill Basin
11235 19.7 31.8 Brighton Beach/Manhattan Beach/Sheepshead Bay
11236 16.1 24.7 Canarsie
11237 18.8 33.3 Bushwick/East Williamsburg
11238 13.0 49.8 Clinton Hill/Prospect Heights
11239 25.4 41.4 East New York
11354 24.7 46.5 Flushing/Murray Hill
11355 24.3 46.1 Flushing/Murray Hill/Queensboro Hill
11356 20.2 40.0 College Point
11357 13.8 46.1 Whitestone
11358 14.0 46.1 Auburndale/Murray Hill
11360 11.0 49.9 Bayside (North)
11361 10.4 46.9 Bayside (North)/Bayside (South)
11362 14.3 48.3 Douglaston-Little Neck
11363 12.8 51.7 Douglaston-Little Neck
11364 8.9 48.1 Bayside (South)/Oakland Gardens
11365 12.3 41.3 Auburndale/Fresh Meadows/Pomonok/Utopia
11366 8.9 41.6 Fresh Meadows/Hillcrest
11367 15.3 36.2 Kew Gardens Hills/Pomonok
11368 19.6 26.4 Corona/North Corona
11369 18.1 37.7 Airport/East Elmhurst
11370 14.8 33.3 Jackson Heights/Rikers Island
11372 17.1 45.5 Jackson Heights
11373 16.1 45.9 Elmhurst
11374 14.9 40.5 Rego Park
11375 11.6 44.4 Forest Hills
11377 15.1 43.5 Woodside
11378 13.2 35.2 Maspeth
11379 14.1 38.8 Middle Village
11385 17.0 31.9 Glendale/Ridgewood
11411 13.2 26.5 Cambria Heights
11412 16.6 25.5 St. Albans
11413 15.5 24.1 Laurelton/Rosedale
11414 14.0 35.0 Hamilton Beach/Howard Beach/Lindenwood
11415 13.8 40.0 Kew Gardens
11416 11.7 32.7 Ozone Park
11417 11.4 36.7 Ozone Park
11418 14.2 35.9 Richmond Hill
11419 13.4 35.0 Richmond Hill/South Ozone Park
11420 12.2 36.3 South Ozone Park
11421 12.3 34.1 Woodhaven
11422 11.5 24.5 Rosedale
11423 12.5 38.5 Hollis/Holliswood
11426 10.2 39.0 Bellerose
11427 13.2 48.7 Bellerose/Hollis Hills/Holliswood
11428 12.0 42.8 Queens Village
11429 12.2 26.2 Queens Village
11432 15.4 45.8 Hillcrest/Jamaica Estates/Jamaica Hills
11433 23.3 28.6 Jamaica
11434 22.8 25.5 Airport/South Jamaica/Springfield Gardens/St. Albans
11435 15.8 34.7 Briarwood/Jamaica
11436 16.2 27.8 South Jamaica/South Ozone Park
11691 21.3 21.9 Edgemere/Far Rockaway
11692 19.2 26.9 Arverne/Edgemere
11693 18.5 32.2 Arverne/Broad Channel
11694 15.6 43.1 Belle Harbor-Neponsit/Rockaway Park
11697 12.2 75.0 Breezy Point

graphic file with name PCD-18-E83s01.jpg

Background

Although COVID-19 is a communicable disease, for many people it could also be a chronic disease (1). In New York City, COVID-19 has had a greater effect on older populations, people living in the outer boroughs of the city’s 5 boroughs (eg, the Bronx, Brooklyn, and Queens, compared with Manhattan), people living in poverty, and racial/ethnic minority populations (2). The availability of a COVID-19 vaccine can lessen the effect of the disease on these populations. As of this writing (April 15, 2021), people in New York City had to schedule an appointment to be vaccinated (3), with certain exceptions (4). Many New Yorkers who wanted to be vaccinated were not able to secure appointments, in part because the supply of COVID-19 vaccine was limited (5). Many public health and health care providers use online systems to schedule appointments; as a result, lack of internet access has been suggested as a potential barrier to vaccination (6). We created a map to visualize the community-level distribution of household internet access and COVID-19 vaccination in New York City.

Data and Methods

We obtained estimates of the percentage of households lacking internet access, by zip code, from NYC Open Data (7). Data on internet access were collected by the 2018 5-year American Community Survey. According to NYC Open Data, the American Community Survey frames this question as having “No access to the internet at this house, apartment, or mobile home.”

We obtained data on zip code–level percentages of adult residents who received at least 1 COVID-19 vaccine dose from the New York City Department of Health and Mental Hygiene website (8). The vaccination data were obtained from the Citywide Immunization Registry. According to the source data table, “People with at least one dose have received at least one dose of two-dose vaccine series or a single dose shot.”

We calculated via simple linear regression the association between the percentage of households without internet access and the percentage of adult residents with at least 1 COVID-19 vaccine dose. Internet access and vaccination data were available for all populated (n = 177) modified zip code tabulation areas in New York City (9). We then classified zip codes into 3 internet-access quantiles (tertiles) and 3 COVID-19 vaccination quantiles and visualized them via a bivariate choropleth map (10). We developed the map in R version 4.0.4 (R Foundation for Statistical Computing) by using the tidyverse (11), sf (12), biscale (13), and cowplot (14) packages. All data were retrieved on April 7, 2021.

Highlights

Among zip codes in New York City, the median percentage of households without internet access was 15.5% (SD, 6.7%), ranging from 0% (zip code 10282, Battery Park City, Manhattan) to 32.4% (zip code 10454, Mott Haven/Port Morris, the Bronx). The median percentage of adults that received at least 1 dose of COVID-19 vaccine was 38.2% (SD, 10.0%), ranging from 21.9% (zip code 11691, Edgemere/Far Rockaway, Queens) to 75.0% (zip code 11697, Breezy Point, Queens). In the simple linear regression model, the percentage of households without internet access was negatively associated with the percentage of adult residents who received at least 1 dose of COVID-19 vaccine (β = −0.92; 95 CI, −1.09 to −0.75; intercept = 53.7%; P < .001, adjusted R 2 = 0.38) (Figure). Most disparities were in the Bronx and Brooklyn.

Figure.

A simple linear regression model shows that, at the zip code level, the percentage of households without internet access was negatively associated with the percentage of adult residents who received at least one dose of COVID-19 vaccine.

Association in New York City, at the zip code level, between the percentage of households without internet access and the percentage of adult residents with at least 1 COVID-19 vaccine dose. Each point represents 1 zip code. The dashed line represents a simple linear regression model, and the shaded area indicates 95% CIs. Linear regression summary: β = −0.92; 95 CI, −1.09 to −0.75; intercept = 53.7%; P < .001; adjusted R 2 = 0.38. Data sources: New York City Department of Health and Mental Hygiene (8), NYC Open Data (7). Data retrieved on April 7, 2021.

Action

COVID-19 vaccination was significantly associated with household internet access in New York City at the zip code level. Although this association neither implies nor precludes causation, and does not control for possible confounders, it is consistent with the hypothesis that lack of internet access is a barrier to vaccination. Internet access is a known social determinant of health (15).

Disparities in internet access exist across multiple socioeconomic dimensions and disproportionately affect low-income neighborhoods (16). A digital health divide in the older population has been widely documented (17). A study published in 2021 suggested that the digital health divide is associated with age, education, income, and race/ethnicity (18).

To facilitate equitable and efficient COVID-19 vaccine uptake in New York City, public health officials should establish appointment-free vaccination sites, work with other agencies and organizations to advocate for legal and policy approaches that increase internet access (19), and increase access to in-person and telephone-based services that provide assistance with vaccine appointment scheduling, especially in zip codes with low rates of internet access. Our map can be used to inform the placement of such interventions. Because most disparities in internet access and vaccination were in zip codes in the Bronx and Brooklyn, appropriate partners for public health officials in these areas include the offices of the borough president, the borough-based New York City Department of Health and Mental Hygiene Neighborhood Health Action Centers, and borough-wide community-based organizations. More generally, we recommend that bivariate mapping be considered when selecting methods for comparing geographic distributions of health determinants and health outcomes.

The availability and accessibility of COVID-19 vaccine in New York City has continued to improve. After this writing, home-based vaccination, appointment-free walk-up vaccination sites, mobile vaccination sites, and pop-up vaccination sites were established (20).

Acknowledgments

No financial support was received for this work. No copyrighted surveys, instruments, or tools were used. The authors have no conflicts of interest.

Footnotes

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: Michaels IH, Pirani SJ, Carrascal A. Disparities in Internet Access and COVID-19 Vaccination in New York City. Prev Chronic Dis 2021;18:210143. DOI: https://doi.org/10.5888/pcd18.210143.

References


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