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 |
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.
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.
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