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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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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>62207</id><entry>2022-12-23</entry><title>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</title><swanseaauthors><author><sid>84f5661b35a729f55047f9e793d8798b</sid><ORCID>0000-0001-7417-2858</ORCID><firstname>Sinead</firstname><surname>Brophy</surname><name>Sinead Brophy</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>ef78c0301f61ea4c72dd0670e61f72df</sid><firstname>Mohamed</firstname><surname>Mhereeg</surname><name>Mohamed Mhereeg</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3fbf9b2f03a3a8f507dd35e9068bd485</sid><firstname>Hope</firstname><surname>Jones</surname><name>Hope Jones</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>fcc7ece0f04577ad5f283b00dd7f52cf</sid><ORCID>0000-0002-4921-7556</ORCID><firstname>Mike</firstname><surname>Seaborne</surname><name>Mike Seaborne</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>a4dfe07a6b18fdf6d537962b8f24fbdf</sid><ORCID>0000-0002-0350-6360</ORCID><firstname>Michael</firstname><surname>Parker</surname><name>Michael Parker</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3f6f07de33204db4c0ab665fb4b36367</sid><firstname>Tash Kennedy</firstname><surname>Kennedy</surname><name>Tash Kennedy Kennedy</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-12-23</date><deptcode>HDAT</deptcode><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 &lt; 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.</abstract><type>Journal Article</type><journal>BMC Infectious Diseases</journal><volume>23</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1471-2334</issnElectronic><keywords>COVID-19 vaccination, Pregnancy, Multimorbidity, Smoking status, Vaccine uptake, Vaccine hesitancy, SAIL Databank</keywords><publishedDay>11</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-09-11</publishedDate><doi>10.1186/s12879-023-08555-8</doi><url>http://dx.doi.org/10.1186/s12879-023-08555-8</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><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</funders><projectreference/><lastEdited>2024-01-08T13:23:07.5643978</lastEdited><Created>2022-12-23T09:58:08.1628799</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Mohamed</firstname><surname>Mhereeg</surname><order>1</order></author><author><firstname>Hope</firstname><surname>Jones</surname><order>2</order></author><author><firstname>Jonathan</firstname><surname>Kennedy</surname><order>3</order></author><author><firstname>Mike</firstname><surname>Seaborne</surname><order>4</order></author><author><firstname>Michael</firstname><surname>Parker</surname><order>5</order></author><author><firstname>Natasha</firstname><surname>Kennedy</surname><order>6</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><order>7</order></author><author><firstname>Luisa</firstname><surname>Zuccolo</surname><order>8</order></author><author><firstname>Amaya</firstname><surname>Azcoaga-Lorenzo</surname><order>9</order></author><author><firstname>Alisha</firstname><surname>Davies</surname><order>10</order></author><author><firstname>Krishnarajah</firstname><surname>Nirantharakumar</surname><order>11</order></author><author><firstname>Sinead</firstname><surname>Brophy</surname><orcid>0000-0001-7417-2858</orcid><order>12</order></author><author><firstname>Mohamed</firstname><surname>Mhereeg</surname><order>13</order></author><author><firstname>Hope</firstname><surname>Jones</surname><order>14</order></author><author><firstname>Mike</firstname><surname>Seaborne</surname><orcid>0000-0002-4921-7556</orcid><order>15</order></author><author><firstname>Michael</firstname><surname>Parker</surname><orcid>0000-0002-0350-6360</orcid><order>16</order></author><author><firstname>Tash Kennedy</firstname><surname>Kennedy</surname><order>17</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>18</order></author></authors><documents><document><filename>62207__28856__f089034a71e842eeaba218ce327754fe.pdf</filename><originalFilename>62207.VOR.pdf</originalFilename><uploaded>2023-10-23T15:23:22.7685797</uploaded><type>Output</type><contentLength>1070773</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© The Author(s) 2023. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 62207 2022-12-23 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 84f5661b35a729f55047f9e793d8798b 0000-0001-7417-2858 Sinead Brophy Sinead Brophy true false ef78c0301f61ea4c72dd0670e61f72df Mohamed Mhereeg Mohamed Mhereeg true false 3fbf9b2f03a3a8f507dd35e9068bd485 Hope Jones Hope Jones true false fcc7ece0f04577ad5f283b00dd7f52cf 0000-0002-4921-7556 Mike Seaborne Mike Seaborne true false a4dfe07a6b18fdf6d537962b8f24fbdf 0000-0002-0350-6360 Michael Parker Michael Parker true false 3f6f07de33204db4c0ab665fb4b36367 Tash Kennedy Kennedy Tash Kennedy Kennedy true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2022-12-23 HDAT 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. Journal Article BMC Infectious Diseases 23 1 Springer Science and Business Media LLC 1471-2334 COVID-19 vaccination, Pregnancy, Multimorbidity, Smoking status, Vaccine uptake, Vaccine hesitancy, SAIL Databank 11 9 2023 2023-09-11 10.1186/s12879-023-08555-8 http://dx.doi.org/10.1186/s12879-023-08555-8 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 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 2024-01-08T13:23:07.5643978 2022-12-23T09:58:08.1628799 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mohamed Mhereeg 1 Hope Jones 2 Jonathan Kennedy 3 Mike Seaborne 4 Michael Parker 5 Natasha Kennedy 6 Ashley Akbari 7 Luisa Zuccolo 8 Amaya Azcoaga-Lorenzo 9 Alisha Davies 10 Krishnarajah Nirantharakumar 11 Sinead Brophy 0000-0001-7417-2858 12 Mohamed Mhereeg 13 Hope Jones 14 Mike Seaborne 0000-0002-4921-7556 15 Michael Parker 0000-0002-0350-6360 16 Tash Kennedy Kennedy 17 Ashley Akbari 0000-0003-0814-0801 18 62207__28856__f089034a71e842eeaba218ce327754fe.pdf 62207.VOR.pdf 2023-10-23T15:23:22.7685797 Output 1070773 application/pdf Version of Record true © The Author(s) 2023. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng https://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Sinead Brophy
Mohamed Mhereeg
Hope Jones
Mike Seaborne
Michael Parker
Tash Kennedy Kennedy
Ashley Akbari
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 84f5661b35a729f55047f9e793d8798b
ef78c0301f61ea4c72dd0670e61f72df
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fcc7ece0f04577ad5f283b00dd7f52cf
a4dfe07a6b18fdf6d537962b8f24fbdf
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author_id_fullname_str_mv 84f5661b35a729f55047f9e793d8798b_***_Sinead Brophy
ef78c0301f61ea4c72dd0670e61f72df_***_Mohamed Mhereeg
3fbf9b2f03a3a8f507dd35e9068bd485_***_Hope Jones
fcc7ece0f04577ad5f283b00dd7f52cf_***_Mike Seaborne
a4dfe07a6b18fdf6d537962b8f24fbdf_***_Michael Parker
3f6f07de33204db4c0ab665fb4b36367_***_Tash Kennedy Kennedy
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Sinead Brophy
Mohamed Mhereeg
Hope Jones
Mike Seaborne
Michael Parker
Tash Kennedy Kennedy
Ashley Akbari
author2 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
Mohamed Mhereeg
Hope Jones
Mike Seaborne
Michael Parker
Tash Kennedy Kennedy
Ashley Akbari
format Journal article
container_title BMC Infectious Diseases
container_volume 23
container_issue 1
publishDate 2023
institution Swansea University
issn 1471-2334
doi_str_mv 10.1186/s12879-023-08555-8
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1186/s12879-023-08555-8
document_store_str 1
active_str 0
description 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.
published_date 2023-09-11T13:23:09Z
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