Social determinants of pertussis and influenza vaccine uptake in pregnancy: A national cohort study in England using electronic health records

Jemma L. Walker; Christopher T. Rentsch; Helen I. McDonald; Jeong Eun Bak; Caroline Minassian; Gayatri Amirthalingam; Michael Edelstein; Sara Thomas

doi:10.1136/bmjopen-2020-046545

Social determinants of pertussis and influenza vaccine uptake in pregnancy: A national cohort study in England using electronic health records

Jemma L. Walker
, Christopher T. Rentsch
, Helen I. McDonald
, Jeong Eun Bak
, Caroline Minassian
, Gayatri Amirthalingam
, Michael Edelstein
, Sara Thomas

Statistics Unit

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

160 Downloads (Pure)

Abstract

Objective: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England.

Design: Nationwide population-based cohort study.

Setting: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data.

Participants: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England.

Main outcome measures: Influenza and pertussis vaccine uptake.

Results: Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy.

Conclusions: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.

Original language	English
Article number	e046545
Journal	BMJ Open
Volume	11
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2020-046545
Publication status	Published - 21 Jun 2021

Bibliographical note

Funding Information: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation (Grant number IS-HPU1112-10096) at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or PHE.

Open Access: https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Citation: Walker JL, Rentsch CT, McDonald HI, et al, Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records, BMJ Open 2021;11:e046545.

DOI: 10.1136/bmjopen-2020-046545

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

maternal medicine
primary care
public health

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Walker2021SocialDeterminantsofPertussisAndInfluenzaVaccineBMJOpenFinal published version, 596 KBLicence: CC BY

Cite this

@article{212a9e2734794610ace6c12285f9561b,

title = "Social determinants of pertussis and influenza vaccine uptake in pregnancy: A national cohort study in England using electronic health records",

abstract = "Objective: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. Design: Nationwide population-based cohort study. Setting: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. Participants: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. Main outcome measures: Influenza and pertussis vaccine uptake. Results: Vaccine uptake was 67.3\% for pertussis and 39.1\% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10\% lower in the most deprived quintiles compared with the least deprived for influenza (34.5\% vs 44.0\%), and almost 20\% lower for pertussis (57.7\% vs 76.0\%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40\%) were not vaccinated in their second eligible pregnancy. Conclusions: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors. ",

keywords = "maternal medicine, primary care, public health",

author = "Walker, \{Jemma L.\} and Rentsch, \{Christopher T.\} and McDonald, \{Helen I.\} and Bak, \{Jeong Eun\} and Caroline Minassian and Gayatri Amirthalingam and Michael Edelstein and Sara Thomas",

note = "Funding Information: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation (Grant number IS-HPU1112-10096) at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or PHE. Open Access: https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. Citation: Walker JL, Rentsch CT, McDonald HI, et al, Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records, BMJ Open 2021;11:e046545. DOI: 10.1136/bmjopen-2020-046545 ",

year = "2021",

month = jun,

day = "21",

doi = "10.1136/bmjopen-2020-046545",

language = "English",

volume = "11",

journal = "BMJ Open",

issn = "2044-6055",

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TY - JOUR

T1 - Social determinants of pertussis and influenza vaccine uptake in pregnancy

T2 - A national cohort study in England using electronic health records

AU - Walker, Jemma L.

AU - Rentsch, Christopher T.

AU - McDonald, Helen I.

AU - Bak, Jeong Eun

AU - Minassian, Caroline

AU - Amirthalingam, Gayatri

AU - Edelstein, Michael

AU - Thomas, Sara

N1 - Funding Information: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Immunisation (Grant number IS-HPU1112-10096) at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or PHE. Open Access: https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. Citation: Walker JL, Rentsch CT, McDonald HI, et al, Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records, BMJ Open 2021;11:e046545. DOI: 10.1136/bmjopen-2020-046545

PY - 2021/6/21

Y1 - 2021/6/21

N2 - Objective: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. Design: Nationwide population-based cohort study. Setting: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. Participants: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. Main outcome measures: Influenza and pertussis vaccine uptake. Results: Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy. Conclusions: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.

AB - Objective: To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. Design: Nationwide population-based cohort study. Setting: The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. Participants: Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. Main outcome measures: Influenza and pertussis vaccine uptake. Results: Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy. Conclusions: Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.

KW - maternal medicine

KW - primary care

KW - public health

UR - https://www.scopus.com/pages/publications/85108508483

U2 - 10.1136/bmjopen-2020-046545

DO - 10.1136/bmjopen-2020-046545

M3 - Article

AN - SCOPUS:85108508483

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e046545

ER -

Social determinants of pertussis and influenza vaccine uptake in pregnancy: A national cohort study in England using electronic health records

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

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