Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study
Abstract
:1. Background
2. Methods
Analysis
3. Results
4. Discussion
- Public health messages need to consider investing greater effort in younger women who may perceive themselves as “healthy”;
- Providers need to understand that women in their third or more pregnancy may need more information about “why” they are still recommended to receive vaccines when they may have received vaccines in prior pregnancies;
- Women with risk factors for respiratory illness such as smokers may need targeted messaging-, e.g., “if you are unable to stop smoking during pregnancy then there are measures you can consider to improve your health and that of your baby”;
- English proficiency, rather than country of birth, influences maternal vaccine uptake.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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YES (N = 42,281) | NO (N = 26,099) | ||||||||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | p-Value | OR | 95%CI | aOR | 95%CI | |
Hospital type | |||||||||
Public | 36,119 | 62.7 | 21,478 | 37.3 | <0.001 | 0.57 | (0.55, 0.59) | 0.65 | (0.63, 0.68) |
Private | 13,018 | 74.8 | 4390 | 25.2 | |||||
Mother born in Australia | |||||||||
Yes | 30,576 | 65.1 | 16,405 | 34.9 | 0.12 | 0.98 | (0.95, 1.01) | 1.03 | (1.00, 1.07) |
No | 18,285 | 65.6 | 9571 | 34.4 | |||||
Parity | |||||||||
First birth | 22,566 | 67.4 | 10,913 | 32.6 | <0.001 | 1.42 | (1.37, 1.48) | 1.37 | (1.31, 1.43) |
2nd birth | 18,005 | 66.2 | 9198 | 33.8 | 1.35 | (1.29, 1.41) | 1.25 | (1.20, 1.31) | |
3rd or more | 8710 | 59.3 | 5988 | 40.7 | ref | ||||
Gestation at first antenatal visit | |||||||||
4–13 weeks | 39,845 | 66.0 | 20,564 | 34.0 | <0.001 | ne | |||
14–27 weeks | 8394 | 63.7 | 4776 | 36.3 | |||||
>27 weeks | 733 | 60.0 | 488 | 40.0 | |||||
Number of antenatal visits | |||||||||
<8 | 10,906 | 61.8 | 6746 | 38.2 | <0.001 | ||||
>=8 | 37,975 | 66.4 | 19,229 | 33.6 | 1.22 | (1.18, 1.26) | 1.08 | (1.04, 1.12) | |
Maternal smoking at any time during this pregnancy | |||||||||
No | 44,156 | 66.1 | 22,660 | 33.9 | <0.001 | ||||
Yes | 2835 | 52.2 | 2591 | 47.8 | 0.56 | (0.53, 0.59) | 0.7 | (0.66, 0.74) | |
Maternal First Nations status | |||||||||
Yes | 641 | 52.2 | 587 | 47.8 | 0.001 | 0.57 | (0.51, 0.63) | 0.83 | (0.74, 0.93) |
No | 48,544 | 65.6 | 25,440 | 34.4 | |||||
Received influenza vaccine during this pregnancy | |||||||||
Yes | 35,969 | 67.2 | 17,567 | 32.8 | 0.001 | 1.33 | (1.28, 1.37) | 1.23 | (1.19, 1.28) |
No | 12,749 | 60.7 | 8241 | 39.3 | |||||
Received pertussis vaccine during this pregnancy | |||||||||
Yes | 41,704 | 67.3 | 20,309 | 32.7 | 0.001 | 1.59 | (1.53, 1.65) | ne | |
No | 7131 | 56.5 | 5495 | 43.5 | |||||
Maternal age (years) | |||||||||
Younger than 20 | 344 | 52.0 | 317 | 48.0 | <0.001 | 0.72 | (0.62, 0.84) | 0.81 | (0.69, 0.95) |
20–29 | 13,161 | 60.1 | 8763 | 40.0 | ref | ||||
30–39 | 33,100 | 67.8 | 15,701 | 32.2 | 1.4 | (1.36, 1.45) | 1.31 | (1.27, 1.36) | |
40 or older | 2675 | 67.1 | 1309 | 32.9 | 1.37 | (1.28, 1.47) | 1.29 | (1.20, 1.39) | |
Discipline of main antenatal care provider | |||||||||
Obstetrician | 30,141 | 67.5 | 14,502 | 32.5 | 0.001 | ne | |||
Midwife | 15,524 | 62.8 | 9199 | 37.2 | |||||
General practitioner | 3287 | 60.9 | 2114 | 39.1 | |||||
None | 57 | 31.1 | 126 | 68.9 | |||||
Other | 193 | 68.0 | 91 | 32.0 | |||||
Maternal proficiency in spoken English * | |||||||||
Very well | 15,074 | 67.7 | 7184 | 32.3 | <0.001 | ||||
Well | 4988 | 66.3 | 2530 | 33.7 | |||||
Not very well | 1435 | 62.6 | 857 | 37.4 | |||||
Not at all | 454 | 61.8 | 281 | 38.2 |
Early Adopter | Late Adopter | Unvaccinated | Unclassifiable | |||||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | p-Value (All Groups) | (Early vs. Late Adopters | |
Hospital type | ||||||||||
Public | 32,527 | 75.4 | 2051 | 75.5 | 21,478 | 82.3 | 3208.0 | 56.0 | <0.001 | 0.796 |
Private | 10,503 | 24.3 | 662 | 24.4 | 4389 | 16.8 | 2456.0 | 42.9 | ||
Other | 108 | 0.3 | 5 | 0.2 | 231 | 0.9 | 61.0 | 1.1 | ||
Mother born in Australia | ||||||||||
Yes | 26,810 | 62.1 | 1613 | 59.4 | 16,405 | 62.9 | 3633.0 | 63.5 | <0.001 | 0.002 |
No | 16,049 | 37.2 | 1074 | 39.5 | 9570 | 36.7 | 1986.0 | 34.7 | ||
Not reported | 319 | 0.7 | 31 | 1.1 | 123 | 0.5 | 106.0 | 1.9 | ||
Parity | ||||||||||
First birth | 19,691 | 45.6 | 1288 | 47.4 | 10,913 | 41.8 | 2542.0 | 44.4 | <0.001 | 0.185 |
2nd birth | 15,804 | 36.6 | 968 | 35.6 | 9197 | 35.2 | 2039.0 | 35.6 | ||
3rd or more | 7683 | 17.8 | 462 | 17.0 | 5988 | 22.9 | 1144.0 | 20.0 | ||
Gestation at first antenatal visit | ||||||||||
4–13 weeks | 34,880 | 80.8 | 2138 | 78.7 | 20,563 | 78.8 | 4693.0 | 82.0 | <0.001 | <0.001 |
14–27 weeks | 7466 | 17.3 | 481 | 17.7 | 4776 | 18.3 | 750.0 | 13.1 | ||
>27 weeks | 577 | 1.3 | 76 | 2.8 | 488 | 1.9 | 160.0 | 2.8 | ||
Not reported | 255 | 0.6 | 23 | 0.9 | 271 | 1.0 | 122.0 | 2.1 | ||
Number of antenatal visits | ||||||||||
<8 | 9549 | 22.1 | 678 | 24.9 | 6746 | 25.9 | 1383.0 | 24.2 | <0.001 | 0.002 |
>=8 | 33,291 | 77.1 | 2022 | 74.4 | 19,232 | 73.7 | 4268.0 | 74.6 | ||
Not reported | 338 | 0.8 | 18 | 0.7 | 120 | 0.5 | 74.0 | 1.3 | ||
Maternal smoking at any time during this pregnancy | ||||||||||
No | 38,714 | 89.7 | 2417 | 88.9 | 22,659 | 86.8 | 5076.0 | 88.7 | <0.001 | 0.001 |
Yes | 2604 | 6.0 | 144 | 5.3 | 2630 | 10.1 | 339.0 | 5.9 | ||
Not reported | 1860 | 4.3 | 157 | 5.8 | 809 | 3.1 | 310.0 | 5.4 | ||
Maternal First Nations status | ||||||||||
Yes | 568 | 1.3 | 46 | 1.7 | 598 | 2.3 | 88.0 | 1.5 | <0.001 | 0.243 |
No | 42,540 | 98.5 | 2667 | 98.1 | 25,439 | 97.5 | 5609.0 | 98.0 | ||
Not reported | 70 | 0.2 | 5 | 0.2 | 61 | 0.2 | 28.0 | 0.5 | ||
Received influenza vaccine during this pregnancy | ||||||||||
Yes | 31,590 | 73.2 | 1947 | 71.6 | 17,566 | 67.3 | 3784.0 | 66.1 | 0.001 | 0.192 |
No | 11,122 | 25.8 | 733 | 27.0 | 8241 | 31.6 | 1666.0 | 29.1 | ||
Not reported | 466 | 1.1 | 38 | 1.4 | 291 | 1.1 | 275.0 | 4.8 | ||
Received pertussis vaccine during this pregnancy | ||||||||||
Yes | 37,031 | 85.8 | 2345 | 86.3 | 20,309 | 77.8 | 3909.0 | 68.3 | 0.001 | 0.049 |
No | 5795 | 13.4 | 339 | 12.5 | 5494 | 21.1 | 1531.0 | 26.7 | ||
Not reported | 352 | 0.8 | 34 | 1.3 | 291 | 1.1 | 282.0 | 4.9 | ||
Maternal age (years) | ||||||||||
Younger than 20 | 307 | 0.7 | 19 | 0.7 | 317 | 1.2 | 45.0 | 0.8 | <0.001 | <0.001 |
20–29 | 11,787 | 27.3 | 699 | 25.7 | 8762 | 33.6 | 1413.0 | 24.7 | ||
30–39 | 28,891 | 66.9 | 1819 | 66.9 | 15,701 | 60.2 | 3818.0 | 66.7 | ||
40 or older | 2193 | 5.1 | 180 | 6.6 | 1309 | 5.0 | 447.0 | 7.8 | ||
Not reported | - | 0.0 | <5 | 0.0 | 9 | 0.0 | <5 | 0.0 | ||
Discipline of main antenatal care provider | ||||||||||
Obstetrician | 25,781 | 59.7 | 1678 | 61.7 | 14,501 | 55.6 | 4173.0 | 72.9 | <0.001 | 0.043 |
Midwife | 14,157 | 32.8 | 855 | 31.5 | 9199 | 35.3 | 1105.0 | 19.3 | ||
General practitioner | 2976 | 6.9 | 165 | 6.1 | 2114 | 8.1 | 314.0 | 5.5 | ||
None | 41 | 0.1 | 7 | 0.3 | 126 | 0.5 | 60.0 | 1.1 | ||
Other | 151 | 0.4 | 10 | 0.4 | 91 | 0.4 | 44.0 | 0.8 | ||
Not reported | 72 | 0.2 | 3 | 0.1 | 67 | 0.3 | 29.0 | 0.5 | ||
Maternal proficiency in spoken English * | ||||||||||
Very well | 13,167 | 30.5 | 940 | 34.6 | 7184 | 27.5 | 1535.0 | 26.8 | <0.001 | <0.001 |
Well | 4299 | 10.0 | 277 | 10.2 | 2529 | 9.7 | 617.0 | 10.8 | ||
Not very well | 1266 | 2.9 | 84 | 3.1 | 857 | 3.3 | 165.0 | 2.9 | ||
Not at all | 408 | 0.9 | 31 | 1.1 | 281 | 1.1 | 64.0 | 1.1 | ||
Not reported | 1063 | 2.5 | 72 | 2.7 | 381 | 1.5 | 191.0 | 3.3 |
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Giles, M.L.; Krishnaswamy, S.; Coote, W.; Davey, M.-A. Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study. Vaccines 2023, 11, 1713. https://doi.org/10.3390/vaccines11111713
Giles ML, Krishnaswamy S, Coote W, Davey M-A. Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study. Vaccines. 2023; 11(11):1713. https://doi.org/10.3390/vaccines11111713
Chicago/Turabian StyleGiles, Michelle L., Sushena Krishnaswamy, William Coote, and Mary-Ann Davey. 2023. "Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study" Vaccines 11, no. 11: 1713. https://doi.org/10.3390/vaccines11111713