(384) Demographic risk factors for vaccine hesitancy

Understanding vaccine hesitancy is paramount in devising strategies to increase uptake of routine vaccines. This need has been highlighted by the COVID-19 pandemic. The purpose of this study is to describe patient characteristics associated with declining routine antepartum vaccination, including the novel COVID-19 vaccine.

Study Design:

This retrospective cohort study included pregnant patients who delivered at a single center between July 1 – September 30, 2021. Patients with unavailable vaccine data were excluded. The findings of interest were refusal of Tdap, influenza, and COVID-19 vaccines during pregnancy. Statistical analysis included Student’s t-test, chi square, and logistic regression, with statistical significance at the p< 0.05 level. A backwards regression model was performed and adjusted for age, insurance type, and race/ethnicity as these factors differed between groups at baseline with p< 0.05.

Results:

Vaccine data was available for 816 patients. The rate of refusal was 54% for COVID vaccine, 43% for influenza vaccine, and 20% for Tdap vaccine. Those who declined the COVID vaccine were younger (33.0 ± 4.8 vs. 34.3 ± 3.8 years, p< 0.001) and less likely to be nulliparous (3% vs. 8%, p< 0.001) than those who accepted the vaccine. Those refusing Tdap were also younger (32.7 ± 4.9 vs. 33.8 ± 4.3 years, p=0.012). Insurance type and race/ethnicity differed across groups for all three vaccines (p < 0.05) (Table 1). However, only public insurance remained independently associated with refusal of all three vaccine types after accounting for confounders, with COVID adjusted odds ratio (aOR) 4.48 (95% CI 2.81 - 7.14), Tdap aOR 4.14 (95% CI 2.6 - 6.62), and flu aOR 3.11 (95% CI 2.04 - 4.74). Younger age remained associated with COVID vaccine refusal only (aOR 0.94, 95%CI 0.91-0.98) (Table 2).

Conclusion:

These findings suggest that pregnant patients enrolled with Medicaid are at increased likelihood of vaccine refusal in pregnancy for all vaccine types. Specific efforts to understand the motivations for refusal may help develop strategies tailored to increasing uptake in this population.