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COVID-19 vaccination in pregnancy: the impact of multimorbidity and smoking status on vaccine hesitancy, a cohort study of 25,111 women in Wales, UK

Mohamed Mhereeg, Hope Jones, Jonathan Kennedy, Mike Seaborne, Michael Parker, Natasha Kennedy, Ashley Akbari, Luisa Zuccolo, Amaya Azcoaga-Lorenzo, Alisha Davies, Krishnarajah Nirantharakumar, Sinead Brophy Orcid Logo, Mohamed Mhereeg, Hope Jones, Mike Seaborne Orcid Logo, Michael Parker Orcid Logo, Tash Kennedy Kennedy, Ashley Akbari Orcid Logo

BMC Infectious Diseases, Volume: 23, Issue: 1

Swansea University Authors: Sinead Brophy Orcid Logo, Mohamed Mhereeg, Hope Jones, Mike Seaborne Orcid Logo, Michael Parker Orcid Logo, Tash Kennedy Kennedy, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1186/s12879-023-08555-8

Abstract

Background: Multimorbidity, smoking status, and pregnancy are identified as three risk factors associated with more severe outcomes following a SARS-CoV-2 infection, thus vaccination uptake is crucial for pregnant women living with multimorbidity and a history of smoking. This study aimed to examine...

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Published in: BMC Infectious Diseases
ISSN: 1471-2334
Published: Springer Science and Business Media LLC 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa62207
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Abstract: Background: Multimorbidity, smoking status, and pregnancy are identified as three risk factors associated with more severe outcomes following a SARS-CoV-2 infection, thus vaccination uptake is crucial for pregnant women living with multimorbidity and a history of smoking. This study aimed to examine the impact of multimorbidity, smoking status, and demographics (age, ethnic group, area of deprivation) on vaccine hesitancy among pregnant women in Wales using electronic health records (EHR) linkage. Methods: This cohort study utilised routinely collected, individual-level, anonymised population-scale linked data within the Secure Anonymised Information Linkage (SAIL) Databank. Pregnant women were identified from 13th April 2021 to 31st December 2021. Survival analysis was employed to examine and compare the length of time to vaccination uptake in pregnancy by considering multimorbidity, smoking status, as well as depression, diabetes, asthma, and cardiovascular conditions independently. The study also assessed the variation in uptake by multimorbidity, smoking status, and demographics, both jointly and separately for the independent conditions, using hazard ratios (HR) derived from the Cox regression model. Results: Within the population cohort, 8,203 (32.7%) received at least one dose of the COVID-19 vaccine during pregnancy, with 8,572 (34.1%) remaining unvaccinated throughout the follow-up period, and 8,336 (33.2%) receiving the vaccine postpartum. Women aged 30 years or older were more likely to have the vaccine in pregnancy. Those who had depression were slightly but significantly more likely to have the vaccine compared to those without depression (HR = 1.08, 95% CI 1.03 to 1.14, p = 0.002). Women living with multimorbidity were 1.12 times more likely to have the vaccine compared to those living without multimorbidity (HR = 1.12, 95% CI 1.04 to 1.19, p = 0.001). Vaccine uptakes were significantly lower among both current smokers and former smokers compared to never smokers (HR = 0.87, 95% CI 0.81 to 0.94, p < 0.001 and HR = 0.92, 95% CI 0.85 to 0.98, p = 0.015 respectively). Uptake was also lower among those living in the most deprived areas compared to those living in the most affluent areas (HR = 0.89, 95% CI 0.83 to 0.96, p = 0.002). Conclusion: Younger women, living without multimorbidity, current and former smokers, and those living in the more deprived areas are less likely to have the vaccine, thus, a targeted approach to vaccinations may be required for these groups. Pregnant individuals living with multimorbidity exhibit a slight but statistically significant reduction in vaccine hesitancy towards COVID-19 during pregnancy.
Keywords: COVID-19 vaccination, Pregnancy, Multimorbidity, Smoking status, Vaccine uptake, Vaccine hesitancy, SAIL Databank
College: Faculty of Medicine, Health and Life Sciences
Funders: This study is part of the National Centre for Population Health and Wellbeing, which is funded by Health Care Research Wales. This study makes use of anonymised data held in the Secure Anonymised Information Linkage (SAIL) Databank. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Welcome Trust. This work was supported by the ADR Wales programme of work. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was additionally supported by funding from the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058), with additional support by The Alan Turing Institute via ‘Towards Turing 2.0’ EPSRC Grant
Issue: 1

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