Background: The aim of this ecological study was to assess the area-level relationship between cumulative death rate for COVID-19 and historic influenza vaccination uptake in the New York City population. Methods: Predictors of COVID-19 death included self-reported influenza vaccination in 2017, as well as four CDC-defined risk factors of severe COVID-19 infection available at the ecological level, which were diabetes, asthma, BMI 30–100 (2 kg/m2) and hypertension, in addition to race and age (65 + years). Results: After adjusting for potential confounders, for every one-unit increase in influenza vaccination uptake for each zip code area, the rate of COVID-19 deaths decreased by 5.17 per 100,000 residents (p < 0.0001). Conclusions: Zip codes with a higher prevalence of influenza vaccination had lower rates of COVID-19 mortality, inciting the need to further explore the relationship between influenza vaccination uptake and COVID-19 mortality at the individual level.

Original languageEnglish
Article number1089
JournalBMC Public Health
Issue number1
StatePublished - Dec 2022


  • COVID-19
  • Influenza vaccination
  • Socioeconomic factors


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