The elderly are a priority population for COVID-19 vaccination. COVID-19 vaccination can effectively reduce the risk of developing severe and critically ill patients or even death in COVID-19 patients. However, the current vaccination rate of the elderly in China is relatively low, and the COVID-19 vaccination behavior among the elderly has been rarely reported in current studies.

To investigate COVID-19 vaccination behavior and its influencing factors among the elderly in China, and to provide a reference for improving the COVID-19 vaccination rate of the elderly.

A total of 1 323 older adults aged 60 years and above in Wujin District of Changzhou City, Zhongmu County of Zhengzhou City, Chengzhong District of Xining City and Linkou County of Mudanjiang City were selected as research subjects from August 3 to August 14 in 2022 by using a stratified random sampling method and investigated by self-designed questionnaires. Binary Logistic regression analysis was used to explore the influencing factors of the first dose of COVID-19 vaccination, full course of COVID-19 vaccination, and booster dose of COVID-19 vaccination.

96.60% (1 278/1 323) of the elderly received the first dose of COVID-19 vaccine, 91.76% (1 214/1 323) completed the full course of COVID-19 vaccination, and 79.67% (1 054/1 323) received the booster dose of COVID-19 vaccine. The results of binary Logistic regression analysis showed that compared with the older adults aged 60-64 years, the older adults aged 75 years and above were less likely to receive the first dose of the COVID-19 vaccine〔OR (95%CI) =0.27 (0.11, 0.62), P<0.05〕; compared with the older adults with chronic disease, the older adults without chronic disease were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =2.07 (1.12, 3.84), P<0.05〕; the older adults with higher levels of perceived benefit were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =1.39 (1.07, 1.79), P<0.05〕. Compared with the older adults aged 60-64 years, who maintained regular physical exercise, those aged 75 years and above〔OR (95%CI) =0.34 (0.19, 0.59), P<0.05〕, who did not maintain regular physical exercise〔OR (95%CI) =0.64 (0.42, 0.96), P<0.05〕were less likely to complete the full course of vaccination; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to complete the full course of the COVID-19 vaccination〔OR (95%CI) =1.59 (1.05, 2.40), P<0.05〕. Compared with older adults aged 60-64 years and from the central region, the older adults aged 75 years and above〔OR (95%CI) =0.55 (0.36, 0.86), P<0.05〕and from the eastern region〔OR (95%CI) =0.47 (0.34, 0.64), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.54 (1.15, 2.06), P<0.05〕; older adults with higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.06 (1.00, 1.11), P<0.05〕. Subgroup analysis showed that compared with the older adults with chronic diseases aged 60-64 years, from the central region, older adults with chronic diseases aged 75 years and above〔OR (95%CI) =0.35 (0.19, 0.65), P<0.05〕, from the eastern region〔OR (95%CI) =0.49 (0.29, 0.83), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; older adults with chronic diseases who had higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.09 (1.01, 1.18), P<0.05〕. Compared with the older adults from the central region without chronic diseases, the older adults from the eastern region without chronic diseases were less likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =0.44 (0.29, 0.68), P<0.05〕.

More attention should be paid to the elderly who are senior and with chronic diseases in the process of COVID-19 vaccination. The vaccination rate of the elderly should be further increased by strengthening the publicity of COVID-19 vaccine knowledge.