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Jones T, Adamali H, Redaniel MT, de Vocht F, Tilling K, Kenward C, Ben-Shlomo Y, Creavin S. The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England. Arch Public Health 2024; 82:118. [PMID: 39113156 PMCID: PMC11304932 DOI: 10.1186/s13690-024-01341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Outreach clinics were part of efforts to maximise uptake in COVID-19 vaccination. METHODS We used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed. RESULTS 50% of 288,473 exposed citizens were white British, and 71% were aged 0-49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was - 0.12% (95% CI: -0.90%, 0.66%); by age group it was - 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%). CONCLUSIONS Living within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.
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Affiliation(s)
- Tim Jones
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Frank de Vocht
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Kate Tilling
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Charlie Kenward
- NHS Bristol, North Somerset, and South Gloucestershire Integrated Care Board, Bristol, UK
| | - Yoav Ben-Shlomo
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2NT, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Sam Creavin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
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Crawshaw AF, Vandrevala T, Knights F, Deal A, Lutumba LM, Nkembi S, Kitoko LM, Hickey C, Forster AS, Hargreaves S. Navigating vaccination choices: The intersecting dynamics of institutional trust, belonging and message perception among Congolese migrants in London, UK (a reflexive thematic analysis). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002620. [PMID: 38985733 PMCID: PMC11236099 DOI: 10.1371/journal.pgph.0002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
The COVID-19 pandemic disproportionately impacted intersectionally marginalised migrants, revealing systemic disparities in health outcomes and vaccine uptake. Understanding the underlying social and structural factors influencing health behaviours is necessary to develop tailored interventions for migrants, but these factors have been seldom explored. This qualitative study aimed to explore contextual factors shaping COVID-19 vaccination decision-making among Congolese migrants in the UK.A community-based participatory research study was designed and led by a community-academic partnership in London, UK (2021-2022). Peer-led, semi-structured interviews were conducted in Lingala with 32 adult Congolese migrants and explored beliefs, perceptions and lived experiences of migration, healthcare, vaccination and the COVID-19 pandemic. Reflexive thematic analysis generated two themes and a model conceptualising the vaccination decision-making process. Participants and community partners were financially compensated; ethics was granted by the University of London ethics committee (REC: 2021.0128).Participants highlighted the incompatibility of lockdown restrictions with their communal culture, which intensified feelings of exclusion and alienation. Concerns about COVID-19 vaccination were attributed to safety and effectiveness, partly informed by experiences and legacies of racial discrimination and exploitation. Inequality in the pandemic response and COVID-19 outcomes heightened participants' sense that their views and needs were being overlooked, and government sources and information were perceived as coercive. Our model depicts the interplay between institutional trust, belonging, and message perception, which shaped participants' vaccination decisions and led to (non-)engagement with COVID-19 vaccination. This research enhances understanding of how social and contextual factors may influence migrants' engagement with health interventions. It underscores the importance of partnering with migrant communities to understand their needs in context and co-design tailored interventions and inclusive messaging strategies that promote trust and belonging. Implementing systemic changes to address structural inequalities will be crucial to create an environment that supports engagement with health-protective behaviours and enhances health outcomes among migrant communities.
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Affiliation(s)
- Alison F. Crawshaw
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University London, London, United Kingdom
| | - Felicity Knights
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| | - Anna Deal
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Muzinga Lutumba
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Sarah Nkembi
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Lusau Mimi Kitoko
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum and Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
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Intimayta-Escalante C, Tapia-Sequeiros G, Rojas-Bolivar D. Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02060-7. [PMID: 38914811 DOI: 10.1007/s40615-024-02060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru. METHODS A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect). RESULTS In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively). CONCLUSION The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.
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Affiliation(s)
| | | | - Daniel Rojas-Bolivar
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud, Lima, Peru
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Howlett N, Fakoya O, Bontoft C, Simmons I, Miners L, Wagner AP, Brown K. A realist evaluation of community champion and participatory action approaches during the COVID-19 pandemic. Front Public Health 2024; 12:1355944. [PMID: 38939557 PMCID: PMC11208485 DOI: 10.3389/fpubh.2024.1355944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 06/29/2024] Open
Abstract
Background During the COVID-19 pandemic, public health teams tried several approaches to circulate accurate health information and engage with community members to understand what they need from public health services. Two such approaches were community champions and community participatory action research (CPAR). This study evaluates two champion programmes and a CPAR programme in terms of what worked, for whom, and in what contexts, including the funding and resourcing associated with implementation. Methods Between June 2022 and June 2023, a realist evaluation of three distinct case studies (COVID-19 champions, Vaccine Champions, and CPAR programmes) in the city of Southampton in England was conducted in three stages: development of initial programme theories and collection of additional contextual information, including funding and resources associated with delivering each programme; initial programme theory testing; synthesis of final programme theories. Data was collected primarily through semi-structured interviews (n = 29) across programme and training leads, voluntary services, community organisations, volunteers, and local community members, and one focus group with local community members (n = 8). Results The City Council used £642 k from two funding awards to deliver the programmes: COVID-19 Champions £41 k; Vaccine Champions £485 k; and CPAR programmes £115 k. Twenty-eight initial programme theories were generated, which were "tested" to support, refine, or refute context-mechanism-outcome relationships, resulting finally in a set of 22 programme theories across the three programmes. Six demi-regularities were generated, each featuring in multiple programme theories, and providing data on how and why these programmes can work, and in which contexts: (1) building trust through community connections; (2) fostering relationships and collaboration; (3) provision of training and resources; (4) local community knowledge and expertise; (5) community representation and leadership; (6) appropriate communication and information sharing. Conclusion This study provides new knowledge and understanding of the factors affecting the implementation of community champion and CPAR approaches during public health emergencies. These findings suggest that representation and involvement of community members, establishing and building on trust, adequate training and resources, and clear communication from trusted community members and organisations are catalysts for meaningful engagement with communities.Evaluation registration: Research Registry identifier: researchregistry8094.
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Affiliation(s)
- Neil Howlett
- Department of Psychology, Sport, and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Olujoke Fakoya
- Department of Psychology, Sport, and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Charis Bontoft
- Department of Psychology, Sport, and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Isobel Simmons
- Department of Psychology, Sport, and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Lisa Miners
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Adam P. Wagner
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Katherine Brown
- Department of Psychology, Sport, and Geography, University of Hertfordshire, Hatfield, United Kingdom
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Hubin P, Van den Borre L, Braeye T, Cavillot L, Billuart M, Stouten V, Nasiadka L, Vermeiren E, Van Evercooren I, Devleesschauwer B, Catteau L, van Loenhout JA. Area and individual level analyses of demographic and socio-economic disparities in COVID-19 vaccination uptake in Belgium. Vaccine X 2024; 18:100496. [PMID: 38779406 PMCID: PMC11108972 DOI: 10.1016/j.jvacx.2024.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Vaccination has played a major role in overcoming the COVID-19 pandemic. However, vaccination status can be influenced by demographic and socio-economic factors at individual and area level. In the context of the LINK-VACC project, the Belgian vaccine register for the COVID-19 vaccination campaign was linked at individual level with other registers, notably the COVID-19 laboratory test results and demographic and socio-economic variables from the DEMOBEL database. The present article aims at investigating to which extent COVID-19 vaccination status is associated with area level and/or individual level demographic and socio-economic factors. From a sample of all individuals tested for SARS-CoV-2 (LINK-VACC sample) demographic and socio-economic indicators are derived and their impact on vaccination coverages at an aggregated geographical level (municipality) is quantified. The same indicators are calculated for the full Belgian population, allowing to assess the representativeness of the LINK-VACC sample with respect to the impact of demographic and socio-economic disparities on vaccination uptake. In a second step, hierarchical models are fitted to the individual level LINK-VACC data to disentangle the individual and municipality effects allowing to evaluate the added value of the availability of individual level data in this context. The most important effects observed at the individual level are reflected in the aggregated data at the municipality level. Multilevel analyses show that most of the demographic and socio-economic impacts on vaccination are captured at the individual level, although accounting for area level in individual level analyses improve the overall description.
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Affiliation(s)
- Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Toon Braeye
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Research Institute of Health and Society, University of Louvain, Brussels, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Léonore Nasiadka
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Elias Vermeiren
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Lièvre G, Sicsic J, Galmiche S, Charmet T, Fontanet A, Mueller JE. Are the 7C psychological antecedents associated with COVID-19 vaccine behaviours beyond intentions? A cross-sectional study on at-least-one-dose and up-to-date vaccination status, and uptake speed among adults in France. Vaccine 2024; 42:3288-3299. [PMID: 38643038 DOI: 10.1016/j.vaccine.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Widely documented psychological antecedents of vaccination are confidence in vaccines, complacency, convenience, calculation, collective responsibility (5C model) with the recent addition of confidence in the wider system and social conformism. While the capacity of these seven antecedents (7C) to explain variance in COVID-19 vaccine intentions has been previously documented, we study whether these factors also are associated with vaccine behaviours, beyond intentions. METHODS From February to June 2022, we recruited a sample of adults in France, including persons with notified recent SARS-CoV-2 infection, along with relatives and randomly selected non-infected persons. Participants completed self-administered questionnaires assessing COVID-19 vaccination history and the 7C antecedents. We defined vaccination behaviours as three outcomes: at-least-one-dose vaccine status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). We conducted multivariable logistic regressions and Cox models. RESULTS Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes, although effects were weaker for up-to-date vaccination status and uptake speed. The strongest effects (most vs. least vaccine-favourable attitude level, at-least-one-dose vaccination status) were observed for collective responsibility (OR: 14.44; 95%CI: 10.72-19.45), calculation (OR: 10.29; 95%CI: 7.53-14.05), and confidence in the wider system (OR: 8.94; 95%CI: 6.51-12.27). CONCLUSION This study demonstrates that the 7C not only explain vaccine intention, but also vaccine behaviours, and underpins the importance of developing vaccine promotion strategies considering the 7C antecedents.
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Affiliation(s)
- Gaëlle Lièvre
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | | | - Simon Galmiche
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | - Tiffany Charmet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309 - F-35000 Rennes, France.
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7
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Goodfellow L, van Leeuwen E, Eggo RM. COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status. BMC Med 2024; 22:162. [PMID: 38616257 DOI: 10.1186/s12916-024-03387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/10/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to have a different population structure-generally younger-which can increase viral transmission due to higher contact rates in school-going children and working-age adults. Higher deprivation is also associated with a higher presence of chronic comorbidities, which were convincingly demonstrated to be risk factors for severe COVID-19 disease. These two major factors need to be combined to better understand and quantify their relative importance in the observed COVID-19 inequalities. METHODS We used UK Census data on health status and demography stratified by decile of the Index of Multiple Deprivation (IMD), which is a measure of socioeconomic deprivation. We calculated epidemiological impact using an age-stratified COVID-19 transmission model, which incorporated different contact patterns and clinical health profiles by decile. To separate the contribution of each factor, we considered a scenario where the clinical health profile of all deciles was at the level of the least deprived. We also considered the effectiveness of school closures and vaccination of over 65-year-olds in each decile. RESULTS In the modelled epidemics in urban areas, the most deprived decile experienced 9% more infections, 13% more clinical cases, and a 97% larger peak clinical size than the least deprived; we found similar inequalities in rural areas. Twenty-one per cent of clinical cases and 16% of deaths in England observed under the model assumptions would not occur if all deciles experienced the clinical health profile of the least deprived decile. We found that more deaths were prevented in more affluent areas during school closures and vaccination rollouts. CONCLUSIONS This study demonstrates that both clinical and demographic factors synergise to generate health inequalities in COVID-19, that improving the clinical health profile of populations would increase health equity, and that some interventions can increase health inequalities.
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Affiliation(s)
- Lucy Goodfellow
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK.
| | - Edwin van Leeuwen
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
- Modelling and Economics Unit and NIHR Health Protection Research Unit in Modelling and Health Economics, UK Health Security Agency, London, NW9 5EQ, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, WC14 7HT, UK
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Crawshaw AF, Kitoko LM, Nkembi SL, Lutumba LM, Hickey C, Deal A, Carter J, Knights F, Vandrevala T, Forster AS, Hargreaves S. Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU). Health Expect 2024; 27:e13884. [PMID: 37831054 PMCID: PMC10726157 DOI: 10.1111/hex.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. METHODS This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. RESULTS Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. CONCLUSIONS Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.
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Affiliation(s)
- Alison F. Crawshaw
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | | | | | | | | | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondonUK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and EducationKingston University LondonLondonUK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
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9
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Barceló MA, Perafita X, Saez M. Spatiotemporal variability in socioeconomic inequalities in COVID-19 vaccination in Catalonia, Spain. Public Health 2024; 227:9-15. [PMID: 38101317 DOI: 10.1016/j.puhe.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Socioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes. STUDY DESIGN A mixed longitudinal ecological study design was used. METHODS Catalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time. RESULTS Areas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes. In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated. Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected. CONCLUSIONS COVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities.
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Affiliation(s)
- M A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - X Perafita
- Observatori-Organisme Autònom de Salut Pública de la Diputació de Girona (Dipsalut), Girona, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain
| | - M Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain. http://www.udg.edu/grecs.htm
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10
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Nafilyan V, Bosworth M, Morgan J, Ayoubkhani D, Dolby T, Groom P, Mills T, Pooley J, Tinsley J. Cohort Profile: The Public Health Data Asset, 2011 cohort. Int J Epidemiol 2024; 53:dyad194. [PMID: 38199788 DOI: 10.1093/ije/dyad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Affiliation(s)
- Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Daniel Ayoubkhani
- Office for National Statistics, Newport, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ted Dolby
- Office for National Statistics, Newport, UK
| | - Paul Groom
- Office for National Statistics, Newport, UK
| | - Tom Mills
- Office for National Statistics, Newport, UK
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11
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Jones G, Perry M, Bailey R, Arumugam S, Edwards A, Lench A, Cooper A, Akbari A, Collins B, Harris C, Richardson G, Barry M, Harris P, Fry R, Lyons RA, Cottrell S. Dimensions of equality in uptake of COVID-19 vaccination in Wales, UK: A multivariable linked data population analysis. Vaccine 2023; 41:7333-7341. [PMID: 37932133 DOI: 10.1016/j.vaccine.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
Vaccination has proven to be effective at preventing severe outcomes of COVID-19 infection, and uptake in the population has been high in Wales. However, there is a risk that high-level vaccination coverage statistics may mask hidden inequalities in under-served populations, many of whom may be at increased risk of severe outcomes of COVID-19 infection. The study population included 1,436,229 individuals aged 18 years and over, alive and residence in Wales as at 31st July 2022, and excluded immunosuppressed or care home residents. We compared people who had received one or more vaccinations to those with no vaccination using linked data from nine datasets within the Secure Anonymised Information Linkage (SAIL) databank. Multivariable analysis was undertaken to determine the impact of a range of sociodemographic characteristics on vaccination uptake, including ethnicity, country of birth, severe mental illness, homelessness and substance use. We found that overall uptake of first dose of COVID-19 vaccination was high in Wales (92.1 %), with the highest among those aged 80 years and over and females. Those aged under 40 years, household composition (aOR 0.38 95 %CI 0.35-0.41 for 10+ size household compared to two adult household) and being born outside the UK (aOR 0.44 95 %CI 0.43-0.46) had the strongest negative associations with vaccination uptake. This was followed by a history of substance misuse (aOR 0.45 95 %CI 0.44-0.46). Despite high-level population coverage in Wales, significant inequalities remain across several underserved groups. Factors associated with vaccination uptake should not be considered in isolation, to avoid drawing incorrect conclusions. Ensuring equitable access to vaccination is essential to protecting under-served groups from COVID-19 and further work needs to be done to address these gaps in coverage, with focus on tailored vaccination pathways and advocacy, using trusted partners and communities.
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Affiliation(s)
- Gethin Jones
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Malorie Perry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Sudha Arumugam
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Adrian Edwards
- Wales COVID-19 Evidence Centre, PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | - Alex Lench
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Brendan Collins
- Health and Social Services Group, Health Protection, Welsh Government, Cardiff, UK; Department of Public Health, Policy and Systems, University of Liverpool, UK.
| | - Caroline Harris
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Gill Richardson
- Policy, Research and International Development, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Mai Barry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Phillippa Harris
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
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12
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Vermeiren E, van Loenhout JAF, Nasiadka L, Stouten V, Billuart M, Van Evercooren I, Catteau L, Hubin P. Factors underlying COVID-19 booster vaccine uptake among adults in Belgium. BMC Res Notes 2023; 16:328. [PMID: 37951923 PMCID: PMC10640742 DOI: 10.1186/s13104-023-06608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE This study aimed to investigate factors influencing the uptake of first and second COVID-19 booster vaccines among adults in Belgium, particularly age, sex, region of residence and laboratory confirmed COVID-19 infection history. RESULTS A binomial regression model was used with having received the first or second booster as outcome and age, sex, region of residence and infection history as fixed variables. Among adults, there was generally a higher uptake to receive the first booster among older age groups compared to younger ones. Females, individuals residing in Flanders and those with no previous COVID-19 infection were more likely to receive the first booster. For the second booster, the same age trend was seen as for the first booster. Males, individuals residing in Flanders and those who tested positive for COVID-19 once after first booster were more likely to receive the second booster. Individuals with multiple positive COVID-19 tests before and after primary course or first booster were less likely to receive the subsequent booster dose compared to COVID-naïve individuals. This information could be used to guide future vaccination campaigns during a pandemic and can provide valuable insights into booster uptake patterns.
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Affiliation(s)
- Elias Vermeiren
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium.
| | | | - Léonore Nasiadka
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
| | - Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
| | - Izaak Van Evercooren
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
| | - Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, 1050, Brussels, Belgium
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13
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Boing AF, Boing AC, Barberia L, Borges ME, Subramanian SV. The Brazilian vaccine divide: How some municipalities were left behind in the Covid-19 vaccine coverage. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002493. [PMID: 37948353 PMCID: PMC10637645 DOI: 10.1371/journal.pgph.0002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
This study aims to assess the progress of geographic, socioeconomic, and demographic disparities in Covid-19 vaccination coverage in Brazil over the first two years of the vaccination campaign. Data from the National Immunization Program Information System were used to estimate covid-19 vaccine coverage. Brazilian municipalities were divided into two groups based on their vaccine coverage for the booster dose. The first group comprised 20% of municipalities with the lowest coverage, while the second group (80% of municipalities) had higher coverage. The analysis was conducted separately for four age groups: 5-11, 12-17, 18-59, and 60+. Explanatory variables included socioeconomic and health services indicators. Crude and adjusted logistic regression models were used to estimate the probability of a municipality being among those with the worst vaccination coverage according to the categories of exploratory variables. Between January/2021 and December/2022, Brazil administered 448.2 million doses of the covid-19 vaccine. The booster vaccination coverage varied from 24.8% among adolescents to 79.7% among the elderly. The difference between the group with the highest and lowest coverage increased during the national vaccination campaign. Municipalities with lower education levels, higher proportion of Black population, higher Gini index, and worse health service indicators had a greater likelihood of having lower vaccination coverage. High and increasing levels of inequality in Covid-19 vaccination were observed in Brazil across all age groups during the vaccination campaign in 2021-2022.
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Affiliation(s)
| | | | | | | | - Sankaran Venkata Subramanian
- Professor at Department of Society, Human Development and Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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14
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Hill EM, Prosser NS, Brown PE, Ferguson E, Green MJ, Kaler J, Keeling MJ, Tildesley MJ. Incorporating heterogeneity in farmer disease control behaviour into a livestock disease transmission model. Prev Vet Med 2023; 219:106019. [PMID: 37699310 DOI: 10.1016/j.prevetmed.2023.106019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
Human behaviour is critical to effective responses to livestock disease outbreaks, especially with respect to vaccination uptake. Traditionally, mathematical models used to inform this behaviour have not taken heterogeneity in farmer behaviour into account. We address this by exploring how heterogeneity in farmers vaccination behaviour can be incorporated to inform mathematical models. We developed and used a graphical user interface to elicit farmers (n = 60) vaccination decisions to an unfolding fast-spreading epidemic and linked this to their psychosocial and behavioural profiles. We identified, via cluster analysis, robust patterns of heterogeneity in vaccination behaviour. By incorporating these vaccination behavioural groupings into a mathematical model for a fast-spreading livestock infection, using computational simulation we explored how the inclusion of heterogeneity in farmer disease control behaviour may impact epidemiological and economic focused outcomes. When assuming homogeneity in farmer behaviour versus configurations informed by the psychosocial profile cluster estimates, the modelled scenarios revealed a disconnect in projected distributions and threshold statistics across outbreak size, outbreak duration and economic metrics.
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Affiliation(s)
- Edward M Hill
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom.
| | - Naomi S Prosser
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - Paul E Brown
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Eamonn Ferguson
- School of Psychology, University Park, University of Nottingham, Nottingham, United Kingdom; National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Green
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - Jasmeet Kaler
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - Matt J Keeling
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Michael J Tildesley
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, United Kingdom
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15
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Morrison K, Cullen L, James AB, Chua V, Sullivan C, Robertson C, Carruthers J, Wood R, Jeffrey K, MacDonald C, Shah SA, Rudan I, Simpson CR, McCowan C, Vittal Katikireddi S, Grange Z, Ritchie L, Sheikh A. Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: Two retrospective cohort analyses of the primary schedule and third dose. Vaccine 2023; 41:5863-5876. [PMID: 37598025 DOI: 10.1016/j.vaccine.2023.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Vaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death. AIM To identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one. METHODS We conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors. RESULTS Of 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period. The most strongly associated predictors for not receiving the second dose were: being aged 18-29 (reference: 50-59 years; aOR:4.26; 95% confidence interval (CI):4.14-4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29-4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16-3.32). The most strongly associated predictors for not receiving the third dose were: being 18-29 (reference: 50-59 years aOR:4.44; 95%CI: 4.38-4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53-2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30-2.46). Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule. CONCLUSION We observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.
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Affiliation(s)
| | - Lucy Cullen
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Vera Chua
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Chris Robertson
- Public Health Scotland, Glasgow, Scotland, UK; University of Strathclyde, Glasgow, UK
| | | | - Rachael Wood
- Public Health Scotland, Glasgow, Scotland, UK; Usher Institute, University of Edinburgh, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Scotland, UK
| | | | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Scotland, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Scotland, UK; School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, Scotland, UK; School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Zoe Grange
- Public Health Scotland, Glasgow, Scotland, UK
| | - Lewis Ritchie
- School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Scotland, UK
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16
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Learoyd AE, Nicholas J, Hart N, Douiri A. Revisiting ethnic discrepancies in COVID-19 hospitalized cohorts: a correction for collider bias. J Clin Epidemiol 2023; 161:94-103. [PMID: 37385305 PMCID: PMC10299938 DOI: 10.1016/j.jclinepi.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Studies from the first waves of the coronavirus disease 2019 (COVID-19) pandemic suggest that individuals from minority ethnicities are at an increased risk of worse outcomes. Concerns exist that this relationship is potentially driven by bias from analyzing hospitalized patients only. We investigate this relationship and the possible presence of bias. STUDY DESIGN AND SETTING Using data from South London hospitals across two COVID-19 waves (February 2020 - May 2021), the relationship between ethnicity and COVID-19 outcomes was examined using regression models. Three iterations of each model were completed: 1) an unadjusted analysis, 2) adjusting for covariates (medical history and deprivation), and 3) adjusting for covariates and bias induced by conditioning on hospitalization. RESULTS Among 3,133 patients, those who were Asian had a two-fold increased risk of death during the hospital stay that was consistent across the two COVID-19 waves and was not affected by correcting for conditioning on hospitalization. However, wave-specific effects demonstrate significant differences between ethnic groups until bias from using a hospitalized cohort was corrected for. CONCLUSION Worsened COVID-19 outcomes in minority ethnicities may be minimized by correcting for bias induced by conditioning on hospitalization. Consideration of this bias should be a key component of study design.
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Affiliation(s)
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Sciences, King College London, London, UK
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17
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Pijpers J, van Roon A, van Roekel C, Labuschagne L, Smagge B, Ferreira JA, de Melker H, Hahné S. Determinants of COVID-19 Vaccine Uptake in The Netherlands: A Nationwide Registry-Based Study. Vaccines (Basel) 2023; 11:1409. [PMID: 37766087 PMCID: PMC10537724 DOI: 10.3390/vaccines11091409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021-18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research.
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Affiliation(s)
- Joyce Pijpers
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Annika van Roon
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Caren van Roekel
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Lisanne Labuschagne
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Bente Smagge
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - José A. Ferreira
- Statistics and Modelling, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Hester de Melker
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
| | - Susan Hahné
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, 3721 MA De Bilt, The Netherlands
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18
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Pouliasi II, Hadjikou A, Kouvari K, Heraclides A. Socioeconomic Inequalities in COVID-19 Vaccine Hesitancy and Uptake in Greece and Cyprus during the Pandemic. Vaccines (Basel) 2023; 11:1301. [PMID: 37631869 PMCID: PMC10459981 DOI: 10.3390/vaccines11081301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
Despite the rigorous investigation of the phenomenon of vaccine hesitancy and refusal during the COVID-19 pandemic, the socioeconomic determinants of this phenomenon remain poorly investigated on a global scale. Following proportional quota sampling, we conducted a population-based cross-sectional study. We recruited participants on-site and online from different settings, regions, and socioeconomic strata in two Eastern Mediterranean populations, Greece and Cyprus. Our approach provided a nationwide sample (n = 576) approaching the adult population structure of the two countries, with a slight underrepresentation of men and older people. Our results indicate clear socioeconomic differences in vaccine hesitancy and vaccination coverage, consistent with wider social inequalities in health. In particular, we reveal a clear socioeconomic gradient characterized by lower vaccine hesitancy and higher vaccination coverage, with increasing educational attainment and income. Additionally, participants residing in semi-urban areas show higher vaccine hesitancy and have lower vaccination coverage than those residing in urban and rural areas. Our results could inform Public Health approaches aiming to tackle the alarming phenomenon of vaccine hesitancy by enabling the targeting of population groups who are particularly vaccine-hesitant, rendering such approaches more targeted and effective while at the same time reducing inequalities in the control and prevention of infectious diseases.
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Affiliation(s)
| | | | | | - Alexandros Heraclides
- Department of Health Sciences, School of Sciences, European University Cyprus, 6 Diogenis Str., 2404 Engomi, P.O. Box 22006, 1516 Nicosia, Cyprus; (I.I.P.); (A.H.); (K.K.)
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19
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Liu H, Nowak GR, Wang J, Luo Z. A National Study of Marital Status Differences in Early Uptake of COVID-19 Vaccine among Older Americans. Geriatrics (Basel) 2023; 8:69. [PMID: 37489317 PMCID: PMC10366868 DOI: 10.3390/geriatrics8040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
We provide one of the first nationally representative studies to examine COVID-19 vaccine uptake differences by marital status within the first year after the vaccine was recommended among older Americans. Data were drawn from the National Health and Aging Trends Study (2021). The study sample included 3180 participants aged 65 and older with 1846 women and 1334 men. Results from logistic regression models suggest that divorced/separated older adults were less likely to receive at least one dose of the COVID-19 vaccine in 2021 than their married counterparts, especially among women and individuals with higher education. Widowed and never married respondents were generally not significantly different from married respondents in COVID-19 vaccination status, with only one exception: less-educated never-married respondents were more likely to receive COVID-19 vaccination than their less-educated married counterparts. Our study highlights divorce/separation as a significant social factor associated with COVID-19 vaccine uptake among older adults in the U.S. These findings suggest that divorced/separated older adults are the most vulnerable population segment at risk of low COVID-19 vaccine uptake. Future efforts to improve vaccine equity and uptake should target this group specifically, with tailored interventions to increase their access and uptake of the vaccine.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, 509 E. Circle Drive 316, East Lansing, MI 48824, USA; (G.R.N.III); (J.W.)
| | - Gerald Roman Nowak
- Department of Sociology, Michigan State University, 509 E. Circle Drive 316, East Lansing, MI 48824, USA; (G.R.N.III); (J.W.)
| | - Juwen Wang
- Department of Sociology, Michigan State University, 509 E. Circle Drive 316, East Lansing, MI 48824, USA; (G.R.N.III); (J.W.)
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA;
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20
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Boing AF, Boing AC, Barberia L, Borges ME, Subramanian SV. Uncovering inequities in Covid-19 vaccine coverage for adults and elderly in Brazil: A multilevel study of 2021-2022 data. Vaccine 2023:S0264-410X(23)00569-8. [PMID: 37221119 DOI: 10.1016/j.vaccine.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
Vaccination is crucial for reducing severe COVID-19 cases, hospitalizations, and deaths. However, vaccine access disparities within countries, particularly in low- and middle-income nations, may leave disadvantaged regions and populations behind. This study aimed to investigate potential inequalities in vaccine coverage among Brazilian aged 18 years and older based on demographic, geographic, and socioeconomic characteristics at the municipal level. A total of 389 million vaccination records from the National Immunization Program Information System were analyzed to calculate vaccine coverage rates for the first, second, and booster doses among adults (18-59 years) and elderly (60 + years) vaccinated between January 2021 and December 2022. We analyzed the data by gender and used a three-level (municipalities, states, regions) multilevel regression analysis to assess the association between vaccine coverage and municipal characteristics. Vaccination coverage was higher among the elderly than among adults, particularly for the second and booster doses. Adult women showed higher coverage rates than men (ranging from 118 % to 25 % higher along the analyzed period). Significant inequalities were observed when analyzing the evolution of vaccination coverage by sociodemographic characteristics of municipalities. In the early stages of the vaccination campaign, municipalities with higher per capita Gross Domestic Product (pGDP), educational level, and fewer Black residents reached higher population coverages earlier. In December 2022, adult and elderly booster vaccine coverage was 43 % and 19 %, respectively, higher in municipalities in the highest quintile of educational level. Higher vaccine uptake was also observed in municipalities with fewer Black residents and higher pGDP. Municipalities accounted for most of the variance in vaccine coverage (59.7 %-90.4 % depending on the dose and age group). This study emphasizes the inadequate booster coverage and the presence of socioeconomic and demographic disparities in COVID-19 vaccination rates. These issues must be addressed through equitable interventions to avoid potential disparities in morbidity and mortality.
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Affiliation(s)
- Antonio Fernando Boing
- Federal University of Santa Catarina, Eng. Agronômico Andrei Cristian Ferreira Street, Florianópolis, SC 88040-900, Brazil
| | - Alexandra Crispim Boing
- Federal University of Santa Catarina, Eng. Agronômico Andrei Cristian Ferreira Street, Florianópolis, SC 88040-900, Brazil
| | - Lorena Barberia
- University of Sao Paulo, 1280 Prof. Almeida Prado Avenue, São Paulo, SP 05508-070, Brazil
| | | | - S V Subramanian
- Harvard T. H. Chan School of Public Health, Department of Society, Human Development and Health, 677 Huntington Ave, Boston, MA 02115, USA
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21
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Chen H, Cao Y, Feng L, Zhao Q, Torres JRV. Understanding the spatial heterogeneity of COVID-19 vaccination uptake in England. BMC Public Health 2023; 23:895. [PMID: 37189026 DOI: 10.1186/s12889-023-15801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Mass vaccination has been a key strategy in effectively containing global COVID-19 pandemic that posed unprecedented social and economic challenges to many countries. However, vaccination rates vary across space and socio-economic factors, and are likely to depend on the accessibility to vaccination services, which is under-researched in literature. This study aims to empirically identify the spatially heterogeneous relationship between COVID-19 vaccination rates and socio-economic factors in England. METHODS We investigated the percentage of over-18 fully vaccinated people at the small-area level across England up to 18 November 2021. We used multiscale geographically weighted regression (MGWR) to model the spatially heterogeneous relationship between vaccination rates and socio-economic determinants, including ethnic, age, economic, and accessibility factors. RESULTS This study indicates that the selected MGWR model can explain 83.2% of the total variance of vaccination rates. The variables exhibiting a positive association with vaccination rates in most areas include proportion of population over 40, car ownership, average household income, and spatial accessibility to vaccination. In contrast, population under 40, less deprived population, and black or mixed ethnicity are negatively associated with the vaccination rates. CONCLUSIONS Our findings indicate the importance of improving the spatial accessibility to vaccinations in developing regions and among specific population groups in order to promote COVID-19 vaccination.
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Affiliation(s)
- Huanfa Chen
- Centre for Advanced Spatial Analysis, University College London, London, UK.
| | - Yanjia Cao
- Department of Geography, The University of Hong Kong, Hong Kong, China
| | - Lingru Feng
- Centre for Advanced Spatial Analysis, University College London, London, UK
- Chongqing Planning and Design Institute, Chongqing, China
- Key Laboratory of Monitoring, Evaluation and Early Warning of Territorial Spatial Planning Implementation, Ministry of Natural Resources, Chongqing, China
| | - Qunshan Zhao
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
- Department of Urban Studies, University of Glasgow, Glasgow, UK
| | - José Rafael Verduzco Torres
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
- Department of Urban Studies, University of Glasgow, Glasgow, UK
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22
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Fontán-Vela M, Gullón P, Bilal U, Franco M. Social and ideological determinants of COVID-19 vaccination status in Spain. Public Health 2023; 219:139-145. [PMID: 37178560 PMCID: PMC10080268 DOI: 10.1016/j.puhe.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES This study analysed the association between social and ideological determinants with COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. STUDY DESIGN This was a repeated cross-sectional study. METHODS The data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political self-placement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one age-adjusted multinomial logistic regression model for each determinant and then stratified them by gender. RESULTS Both social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08-1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02-4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62-5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54-2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. CONCLUSIONS Considering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities.
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Affiliation(s)
- M Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Instituto de Lengua, Literatura y Antropología, Centro Superior de Investigaciones Sociológicas, Ministerio de Ciencia e Innovación, Spain
| | - P Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - U Bilal
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - M Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2217, USA
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23
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Hirst J, Mi E, Copland E, Patone M, Coupland C, Hippisley-Cox J. Uptake of COVID-19 vaccination in people with blood cancer: Population-level cohort study of 12 million patients in England. Eur J Cancer 2023; 183:162-170. [PMID: 36870190 PMCID: PMC9916184 DOI: 10.1016/j.ejca.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND People with blood cancers have increased risk of severe outcomes from COVID-19 and were prioritised for vaccination. METHODS Individuals in the QResearch database aged 12 years and above on 1st December 2020 were included in the analysis. Kaplan-Meier analysis described time to COVID-19 vaccine uptake in people with blood cancer and other high-risk disorders. Cox regression was used to identify factors associated with vaccine uptake in people with blood cancer. RESULTS The analysis included 12,274,948 individuals, of whom 97,707 had a blood cancer diagnosis. 92% of people with blood cancer received at least one dose of vaccine, compared to 80% of the general population, but there was lower uptake of each subsequent vaccine dose (31% for fourth dose). Vaccine uptake decreased with social deprivation (HR 0.72, 95% CI 0.70, 0.74 for most deprived versus most affluent quintile for first vaccine). Compared with White groups, uptake of all vaccine doses was significantly lower in people of Pakistani and Black ethnicity, and more people in these groups remain unvaccinated. CONCLUSIONS COVID-19 vaccine uptake declines following second dose and there are ethnic and social disparities in uptake in blood cancer populations. Enhanced communication of benefits of vaccination to these groups is needed.
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Affiliation(s)
- Jennifer Hirst
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Emma Mi
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Emma Copland
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Martina Patone
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carol Coupland
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK; Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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24
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Hansen BT, Labberton AS, Kour P, Kraft KB. Coverage of primary and booster vaccination against COVID-19 by socioeconomic level: A nationwide cross-sectional registry study. Hum Vaccin Immunother 2023; 19:2188857. [PMID: 36941785 PMCID: PMC10072069 DOI: 10.1080/21645515.2023.2188857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
High and equitable COVID-19 vaccination coverage is important for pandemic control and prevention of health inequity. However, little is known about socioeconomic correlates of booster vaccination coverage. In this cross-sectional study of all Norwegian adults in the national vaccination program (N = 4,190,655), we use individual-level registry data to examine coverage by levels of household income and education of primary (≥2 doses) and booster (≥3 doses) vaccination against COVID-19. We stratify the analyses by age groups with different booster recommendations and report relative risk ratios (RR) for vaccination by 25 August 2022. In the 18-44 y group, individuals with highest vs. lowest education had 94% vs. 79% primary coverage (adjusted RR (adjRR) 1.15, 95%CI 1.14-1.15) and 67% vs. 38% booster coverage (adjRR 1.55, 95% CI 1.55-1.56), while individuals with highest vs. lowest income had 94% vs. 81% primary coverage (adjRR 1.10, 95%CI 1.10-1.10) and 60% vs. 43% booster coverage (adjRR 1.23, 95%CI 1.22-1.24). In the ≥45 y group, individuals with highest vs. lowest education had 96% vs. 92% primary coverage (adjRR 1.02, 95%CI 1.02-1.02) and 88% vs. 80% booster coverage (adjRR 1.09, 95%CI 1.09-1.09), while individuals with highest vs. lowest income had 98% vs. 82% primary coverage (adjRR 1.16, 95%CI 1.16-1.16) and 92% vs. 64% booster coverage (adjRR 1.33, 95%CI 1.33-1.34). In conclusion, we document large socioeconomic inequalities in COVID-19 vaccination coverage, especially for booster vaccination, even though all vaccination was free-of-charge. The results highlight the need to tailor information and to target underserved groups for booster vaccination.
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Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Angela S Labberton
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Prabhjot Kour
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian B Kraft
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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25
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Sheikh NS, Winje BA, Gleditsch R, Nordstrøm C, Vedaa Ø, Kour P, Gele A. Vaksineusikkerhet blant innvandrere under covid-19-pandemien – en kvalitativ studie. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:22-0098. [PMID: 36919303 DOI: 10.4045/tidsskr.22.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Vaccination against SARS-CoV-2 has been an important measure in dealing with the pandemic. In Norway, vaccination coverage has been lower in several immigrant groups than in the general population. The aim of this study was to investigate which factors may have played a role in the low uptake rate among immigrants. MATERIAL AND METHOD Eighty-eight semi-structured, qualitative interviews were conducted remotely in the period March to June 2021. The interviewees consisted of 49 women and 39 men aged 19-78, from ten different countries. In a thematic analysis (NVivo-12), four main categories relating to vaccine hesitancy emerged: system-based factors, factors linked to personal conviction, factors linked to fear and factors linked to trust. RESULTS Although many of the informants were willing to take the vaccine, several expressed vaccine hesitancy. Lack of evidence-based information and fear of adverse effects were cited as reasons. Vaccine hesitancy was also linked to misinformation and conspiracy theories. Some had no confidence in the vaccination programme or the efficacy of the vaccine. INTERPRETATION The study revealed that vaccine hesitancy among immigrants was due to a range of factors. The main reasons included lack of information, low health literacy, insufficient knowledge of how the vaccine works, and little trust in the authorities.
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Affiliation(s)
- Naima Said Sheikh
- Område for helsetjenester, Klynge for forskning og analyse av helsetjenesten, Folkehelseinstituttet, og, Institutt for folkehelsevitenskap, Norges miljø- og biovitenskapelige universitet
| | - Brita Askeland Winje
- Område for smittevern, Avdeling for smittevern og vaksine, Folkehelseinstituttet, og, Fakultet for helsefag, OsloMet
| | - Rebecca Gleditsch
- Område for smittevern, Avdeling for smittevern og vaksine, Folkehelseinstituttet
| | - Charlott Nordstrøm
- Område for helsetjenester, Klynge for forskning og analyse av helsetjenesten, Folkehelseinstituttet
| | - Øystein Vedaa
- Område for psykisk og fysisk helse, Avdeling for helsefremmende arbeid, Folkehelseinstituttet, og, Institutt for samfunnspsykologi, Universitetet i Bergen
| | - Prabhjot Kour
- Område for smitte fra mat, vann og dyr, Folkehelseinstituttet
| | - Abdi Gele
- Område for helsetjenester, Klynge for forskning og analyse av helsetjenesten, Folkehelseinstituttet
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26
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Wang Z, Chan K, Poon AN, Guo Y. An equitable route forward from China's 'zero COVID' policy. Nat Med 2023; 29:514-515. [PMID: 36627341 DOI: 10.1038/d41591-023-00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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27
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Larsen T, Bosworth ML, Ayoubkhani D, Schofield R, Ali R, Khunti K, Walker AS, Glickman M, Harrison C, Nafilyan V. Inequalities in SARS-CoV-2 case rates by ethnicity, religion, measures of socioeconomic position, English proficiency, and self-reported disability: cohort study of 39 million people in England during the alpha and delta waves. BMJ MEDICINE 2023; 2:e000187. [PMID: 37063237 PMCID: PMC10568121 DOI: 10.1136/bmjmed-2022-000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 01/18/2023] [Indexed: 04/05/2023]
Abstract
Objective To examine sociodemographic inequalities in people with SARS-CoV-2 during the second (alpha) and third (delta) waves of the covid-19 pandemic. Design Retrospective, population based cohort study. Setting Resident population of England. Participants 39 006 194 people aged 10 years and older who were enumerated in the 2011 census, registered with the NHS, and alive on 1 September 2020. Main outcome measures Age standardised SARS-CoV-2 case rates (ie, the number of people who received a positive test result per 100 000 person weeks at risk) during the second wave (1 September 2020 to 22 May 2021) or third wave (23 May to 10 December 2021) of the pandemic. Age standardised rates were calculated by sociodemographic characteristics and adjusted rate ratios were estimated using generalised linear regression models with a Poisson distribution (models were adjusted for covariates including sex, age, geographical variables, and sociodemographic characteristics). Results During the study period, 5 767 584 people (14.8% of the study population) tested positive for SARS-CoV-2. In the second wave, the fully adjusted relative risks of having a positive test were highest for the Bangladeshi and Pakistani ethnic groups compared with the white British group, with rate ratios of 1.75 (95% confidence interval 1.73 to 1.77) and 1.69 (1.68 to 1.70), respectively. Muslim and Sikh religious groups had fully adjusted rate ratios of 1.51 (1.50 to 1.51) and 1.64 (1.63 to 1.66), respectively, compared with the Christian group. Greater area deprivation, disadvantaged socioeconomic position, living in a care home, and low English language proficiency were also associated with higher relative risk of having a positive test. However, the inequalities among groups varied over time. Being Christian, white British, without a disability, and from a more advantaged socioeconomic position were associated with increased relative risk of testing positive during the third wave. Conclusion Research is urgently needed to understand the large sociodemographic inequalities in SARS-CoV-2 case rates in order to inform policy interventions in future waves or pandemics.
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Affiliation(s)
- Tim Larsen
- Office for National Statistics, Newport, UK
| | | | | | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ann Sarah Walker
- Nuffield Department of Medicine, Univerity of Oxford, Oxford, UK
| | | | | | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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28
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McPeake J, Blayney M, Stewart N, Kaye C, Chan Seem R, Hall R, Martin C, Paton M, Wise A, Puxty K, Lone N. COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study. Int J Obstet Anesth 2023; 53:103613. [PMID: 36564271 PMCID: PMC9715259 DOI: 10.1016/j.ijoa.2022.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.
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Affiliation(s)
- J. McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, UK,Corresponding author at: Glasgow Royal Infirmary, 84 Castle St., Glasgow, G4 OSF, UK
| | - M.C. Blayney
- Usher Institute, University of Edinburgh, UK,Public Health Scotland, UK
| | | | | | | | | | | | | | | | - K. Puxty
- NHS Greater Glasgow and Clyde, UK,University of Glasgow, School of Medicine, Dentistry and Nursing, Scotland, UK
| | - N.I. Lone
- Usher Institute, University of Edinburgh, UK,NHS Lothian, Scotland, UK
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29
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Bosworth ML, Ahmed T, Larsen T, Lorenzi L, Morgan J, Ali R, Goldblatt P, Islam N, Khunti K, Raleigh V, Ayoubkhani D, Bannister N, Glickman M, Nafilyan V. Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine rollout: a retrospective, population-based cohort study. BMC Med 2023; 21:13. [PMID: 36617562 PMCID: PMC9826727 DOI: 10.1186/s12916-022-02704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. METHODS We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30-100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. RESULTS Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72-2.78]; women: 2.12 [1.58-2.86]) and Pakistani men (1.24 [1.06-1.46]). CONCLUSIONS Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.
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Affiliation(s)
- Matthew L Bosworth
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Tamanna Ahmed
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Tim Larsen
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Luke Lorenzi
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Jasper Morgan
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Raghib Ali
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Peter Goldblatt
- UCL Institute of Health Equity, Department of Epidemiology & Public Health, University College London, London, WC1E 7HB, UK
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.,School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO17 1BJ, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Veena Raleigh
- The King's Fund, 11-13 Cavendish Square, London, W1G 0AN, UK
| | - Daniel Ayoubkhani
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Neil Bannister
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Myer Glickman
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK
| | - Vahé Nafilyan
- Office for National Statistics, Health Analysis and Life Events, Newport, NP10 8XG, UK. .,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
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30
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Spetz M, Lundberg L, Nwaru C, Li H, Santosa A, Ng N, Leach S, Gisslén M, Hammar N, Nyberg F, Rosvall M. An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden. Vaccine 2022; 40:6640-6648. [PMID: 36210254 PMCID: PMC9515344 DOI: 10.1016/j.vaccine.2022.09.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. METHODS National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FINDINGS By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. INTERPRETATION Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FUNDING SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.
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Affiliation(s)
- M. Spetz
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Gotaland, Gothenburg, Sweden,Corresponding author at: School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 463, 405 30 Gothenburg, Sweden
| | - L. Lundberg
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - C. Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - H. Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - A. Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - N. Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - S. Leach
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - M. Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - N. Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - F. Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - M. Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden,Department of Social Medicine, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
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Sides E, Jones LF, Kamal A, Thomas A, Syeda R, Kaissi A, Lecky DM, Patel M, Nellums L, Greenway J, Campos-Matos I, Shukla R, Brown CS, Pareek M, Sollars L, Pawson E, McNulty C. Attitudes towards coronavirus (COVID-19) vaccine and sources of information across diverse ethnic groups in the UK: a qualitative study from June to October 2020. BMJ Open 2022; 12:e060992. [PMID: 36581971 PMCID: PMC9437733 DOI: 10.1136/bmjopen-2022-060992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Across diverse ethnic groups in the UK, explore attitudes and intentions towards COVID-19 vaccination and sources of COVID-19 information. DESIGN Remote qualitative interviews and focus groups (FGs) conducted June-October 2020 before UK COVID-19 vaccine approval. Data were transcribed and analysed through inductive thematic analysis and mapped to the Theoretical Domains Framework. SETTING England and Wales. PARTICIPANTS 100 participants from 19 self-identified ethnic groups. RESULTS Mistrust and doubt were reported across ethnic groups. Many participants shared concerns about perceived lack of information about COVID-19 vaccine safety and efficacy. There were differences within each ethnic group, with factors such as occupation and perceived health status influencing intention to accept a vaccine once made available. Across ethnic groups, participants believed that public contact occupations, older adults and vulnerable groups should be prioritised for vaccination. Perceived risk, social influences, occupation, age, comorbidities and engagement with healthcare influenced participants' intentions to accept vaccination once available. All Jewish FG participants intended to accept, while all Traveller FG participants indicated they probably would not.Facilitators to COVID-19 vaccine uptake across ethnic groups included: desire to return to normality and protect health and well-being; perceived higher risk of infection; evidence of vaccine safety and efficacy; vaccine availability and accessibility.COVID-19 information sources were influenced by social factors and included: friends and family; media and news outlets; research literature; and culture and religion. Participants across most different ethnic groups were concerned about misinformation or had negative attitudes towards the media. CONCLUSIONS During vaccination rollout, including boosters, commissioners and providers should provide accurate information, authentic community outreach and use appropriate channels to disseminate information and counter misinformation. Adopting a context-specific approach to vaccine resources, interventions and policies and empowering communities has potential to increase trust in the programme.
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Affiliation(s)
- Eirwen Sides
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
| | - Leah Ffion Jones
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
| | - Atiya Kamal
- Psychology, Birmingham City University, Birmingham, UK
| | - Amy Thomas
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
| | - Rowshonara Syeda
- Prevention Strategy & Innovation Team, UK Department of Health and Social Care, London, UK
| | - Awatif Kaissi
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
| | - Donna M Lecky
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
| | - Mahendra Patel
- School of Pharmacy and Medical Sciences (Faculty of Life Sciences), University of Bradford, Bradford, UK
| | - Laura Nellums
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | | | - Colin S Brown
- Bacteria Reference Department, National Infection Service, UKHSA, London, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Emma Pawson
- UK Department of Health and Social Care, London, UK
| | - Cliodna McNulty
- Primary Care and Interventions Unit, UKHSA South West, Bristol, UK
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