Multiscale Dimensions of Spatial Process: COVID-19 Fully Vaccinated Rates in U.S. Counties

Introduction: This study aimed to examine the heterogeneity of the associations between social determinants and COVID-19 fully vaccinated rate. Methods: This study proposes 3 multiscale dimensions of spatial process, including level of influence (the percentage of population affected by a certain determinant across the entire area), scalability (the spatial process of a determinant into global, regional, and local process), and specificity (the determinant that has the strongest association with the fully vaccinated rate). The multiscale geographically weighted regression was applied to the COVID-19 fully vaccinated rates in U.S. counties (N=3,106) as of October 26, 2021, and the analyses were conducted in May 2022. Results: The results suggest the following: (1) Percentage of Republican votes in the 2020 presidential election is a primary influencer because 84% of the U.S. population lived in counties where this determinant is found the most dominant; (2) Demographic compositions (e.g., percentages of racial/ethnic minorities) play a larger role than socioeconomic conditions (e.g., unemployment) in shaping fully vaccinated rates; (3) The spatial process underlying fully vaccinated rates is largely local. Conclusions: The findings challenge the 1-size-fits-all approach to designing interventions promoting COVID-19 vaccination and highlight the importance of a place-based perspective in ecological health research.