BACKGROUND: Between January 2020 and December 2023, the United States reported over 103 million COVID-19 cases and 1.1 million related deaths. Veterans with spinal cord injuries and disorders (VSCI/D) are particularly vulnerable due to chronic health conditions and comorbidities, which increases COVID-19 infection and mortality risk from exposure to others who they depend on for care. This manuscript highlights factors associated with COVID-19 vaccine uptake in VSCI/D.

OBJECTIVE: This study aimed to explore Veteran demographic and clinical factors associated with COVID-19 test positivity, vaccine uptake, and COVID-19-related mortality among VSCI/D in the 2-year period following the start of the pandemic.

METHODS: This observational cohort study used the Veterans Health Administration's (VHA) Spinal Cord Injuries and Disorders Registry to identify VSCI/D alive on March 20, 2020. Outcome measures included COVID-19 test positivity, vaccine uptake, and mortality within 30 days of a positive test over a 2-year period.

RESULTS: Among 17,522 VSCI/D, 12% had a positive COVID-19 test at least once in the two-year period following March 20, 2020, 73% received at least one COVID-19 vaccine dose in the 2-year period, and 47% received at least three doses. COVID-related mortality occurred in 67 (0.4%; 67/17,522) VSCI/D in the first year of the pandemic and 46 in the second year (0.6% two-year mortality; 113/17,522).

CONCLUSION: Less than half of VSCI/D received three COVID-19 vaccine doses, suggesting opportunities for quality improvement efforts. Peer support services may help improve vaccine uptake among VSCI/D in the future.