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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 Orcid Logo, Michael Parker Orcid Logo, Tash Kennedy Orcid Logo, Ashley Akbari Orcid Logo, Luisa Zuccolo, Amaya Azcoaga-Lorenzo, Alisha Davies, Krishnarajah Nirantharakumar, Sinead Brophy Orcid Logo

BMC Infectious Diseases, Volume: 23, Issue: 1

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

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

Abstract

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...

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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/cronfa64540
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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.MethodsThis 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.ResultsWithin 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&#x2009;=&#x2009;1.08, 95% CI 1.03 to 1.14, p&#x2009;=&#x2009;0.002). Women living with multimorbidity were 1.12 times more likely to have the vaccine compared to those living without multimorbidity (HR&#x2009;=&#x2009;1.12, 95% CI 1.04 to 1.19, p&#x2009;=&#x2009;0.001). Vaccine uptakes were significantly lower among both current smokers and former smokers compared to never smokers (HR&#x2009;=&#x2009;0.87, 95% CI 0.81 to 0.94, p&#x2009;&lt;&#x2009;0.001 and HR&#x2009;=&#x2009;0.92, 95% CI 0.85 to 0.98, p&#x2009;=&#x2009;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&#x2009;=&#x2009;0.89, 95% CI 0.83 to 0.96, p&#x2009;=&#x2009;0.002).ConclusionYounger 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 Data</keywords><publishedDay>11</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-09-11</publishedDate><doi>10.1186/s12879-023-08555-8</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>This work was funded by the National Core Studies, an initiative funded by UKRI, NIHR and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17).</funders><projectreference/><lastEdited>2024-10-18T17:11:17.6684525</lastEdited><Created>2023-09-13T17:07:12.3752523</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</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><orcid/><order>3</order></author><author><firstname>Mike</firstname><surname>Seaborne</surname><orcid>0000-0002-4921-7556</orcid><order>4</order></author><author><firstname>Michael</firstname><surname>Parker</surname><orcid>0000-0002-0350-6360</orcid><order>5</order></author><author><firstname>Tash</firstname><surname>Kennedy</surname><orcid>0000-0002-1500-7112</orcid><order>6</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><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></authors><documents><document><filename>64540__28537__0a36ca6247bc47a1badc163450391291.pdf</filename><originalFilename>64540.VOR.pdf</originalFilename><uploaded>2023-09-13T17:20:58.4119039</uploaded><type>Output</type><contentLength>1070773</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2023. 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spelling 2024-10-18T17:11:17.6684525 v2 64540 2023-09-13 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 ef78c0301f61ea4c72dd0670e61f72df Mohamed Mhereeg Mohamed Mhereeg true false 3fbf9b2f03a3a8f507dd35e9068bd485 Hope Jones Hope Jones true false 08163d1f58d7fefcb1c695bcc2e0ef68 Jonathan Kennedy Jonathan Kennedy 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 0000-0002-1500-7112 Tash Kennedy Tash Kennedy true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 84f5661b35a729f55047f9e793d8798b 0000-0001-7417-2858 Sinead Brophy Sinead Brophy true false 2023-09-13 MEDS 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.MethodsThis 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.ResultsWithin 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).ConclusionYounger 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 Data 11 9 2023 2023-09-11 10.1186/s12879-023-08555-8 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) This work was funded by the National Core Studies, an initiative funded by UKRI, NIHR and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). 2024-10-18T17:11:17.6684525 2023-09-13T17:07:12.3752523 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Mohamed Mhereeg 1 Hope Jones 2 Jonathan Kennedy 3 Mike Seaborne 0000-0002-4921-7556 4 Michael Parker 0000-0002-0350-6360 5 Tash Kennedy 0000-0002-1500-7112 6 Ashley Akbari 0000-0003-0814-0801 7 Luisa Zuccolo 8 Amaya Azcoaga-Lorenzo 9 Alisha Davies 10 Krishnarajah Nirantharakumar 11 Sinead Brophy 0000-0001-7417-2858 12 64540__28537__0a36ca6247bc47a1badc163450391291.pdf 64540.VOR.pdf 2023-09-13T17:20:58.4119039 Output 1070773 application/pdf Version of Record true © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, true eng http://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
Mohamed Mhereeg
Hope Jones
Jonathan Kennedy
Mike Seaborne
Michael Parker
Tash Kennedy
Ashley Akbari
Sinead Brophy
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 ef78c0301f61ea4c72dd0670e61f72df
3fbf9b2f03a3a8f507dd35e9068bd485
08163d1f58d7fefcb1c695bcc2e0ef68
fcc7ece0f04577ad5f283b00dd7f52cf
a4dfe07a6b18fdf6d537962b8f24fbdf
3f6f07de33204db4c0ab665fb4b36367
aa1b025ec0243f708bb5eb0a93d6fb52
84f5661b35a729f55047f9e793d8798b
author_id_fullname_str_mv ef78c0301f61ea4c72dd0670e61f72df_***_Mohamed Mhereeg
3fbf9b2f03a3a8f507dd35e9068bd485_***_Hope Jones
08163d1f58d7fefcb1c695bcc2e0ef68_***_Jonathan Kennedy
fcc7ece0f04577ad5f283b00dd7f52cf_***_Mike Seaborne
a4dfe07a6b18fdf6d537962b8f24fbdf_***_Michael Parker
3f6f07de33204db4c0ab665fb4b36367_***_Tash Kennedy
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
84f5661b35a729f55047f9e793d8798b_***_Sinead Brophy
author Mohamed Mhereeg
Hope Jones
Jonathan Kennedy
Mike Seaborne
Michael Parker
Tash Kennedy
Ashley Akbari
Sinead Brophy
author2 Mohamed Mhereeg
Hope Jones
Jonathan Kennedy
Mike Seaborne
Michael Parker
Tash Kennedy
Ashley Akbari
Luisa Zuccolo
Amaya Azcoaga-Lorenzo
Alisha Davies
Krishnarajah Nirantharakumar
Sinead Brophy
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 - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.MethodsThis 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.ResultsWithin 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).ConclusionYounger 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 2023-09-11T02:42:38Z
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