*Article* **Sociodemographic Factors Associated with COVID-19 Vaccination among People in Guatemalan Municipalities**

**Rewa Choudhary 1,\*, Emily Carter 2, Jose Monzon 3, Allison Stewart 3, Jennifer Slotnick 4, Leslie L. Samayoa Jerez 5, David S. Rodriguez Araujo 6, Emily Zielinski-Gutierrez <sup>3</sup> and Parminder S. Suchdev <sup>3</sup>**

	- <sup>3</sup> Centers for Disease Control and Prevention Central America Regional Office,
		- Guatemala City 01015, Guatemala
	- <sup>4</sup> U.S. Agency for International Development (USAID), Guatemala City 01016, Guatemala

**Abstract:** The Republic of Guatemala's reported COVID-19 vaccination coverage is among the lowest in the Americas and there are limited studies describing the disparities in vaccine uptake within the country. We performed a cross-sectional ecological analysis using multi-level modeling to identify sociodemographic characteristics that were associated with low COVID-19 vaccination coverage among Guatemalan municipalities as of 30 November 2022. Municipalities with a higher proportion of people experiencing poverty (β = −0.25, 95% CI: −0.43–−0.07) had lower vaccination coverage. Municipalities with a higher proportion of people who had received at least a primary education (β = 0.74, 95% CI: 0.38–1.08), children (β = 1.07, 95% CI: 0.36–1.77), people aged 60 years and older (β = 2.94, 95% CI: 1.70–4.12), and testing for SARS-CoV-2 infection (β = 0.25, 95% CI: 0.14–0.36) had higher vaccination coverage. In the simplified multivariable model, these factors explained 59.4% of the variation in COVID-19 vaccination coverage. Poverty remained significantly associated with low COVID-19 vaccination coverage in two subanalyses restricting the data to the time period of the highest national COVID-19-related death rate and to COVID-19 vaccination coverage only among those aged 60 years or older. Poverty is a key factor associated with low COVID-19 vaccination and focusing public health interventions in municipalities most affected by poverty may help address COVID-19 vaccination and health disparities in Guatemala.

**Keywords:** COVID-19 vaccination; Guatemala; equity
