Abstract
Background: Pregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage. Methods: We conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI). Results: There were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67–0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10–1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72–0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40–1.48). Conclusions: Compared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.
| Original language | English |
|---|---|
| Article number | 314 |
| Journal | BMC Pregnancy and Childbirth |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Dec 2023 |
Bibliographical note
Funding Information:This project was supported by a National Health and Medical Research Council (NHMRC) Project Grant (GNT1141510) and operational funds provided by the Department of Health Western Australia. LMc was funded through a University of Queensland Early Career Research Fellowship. AKR was supported by an NHMRC Early Career Fellowship (GNT1138425). HCM was supported by a Stan Perron Charitable Foundation People Fellowship. CCB was supported by an NHMRC Career Development Fellowship (GNT1111596) and NHMRC Investigator award (APP1173163). MJB was supported by an NHMRC Early Career Fellowship (GNT1088733) and NHMRC funded Hot North - Improving Health Outcomes in the Tropical North – Fellowship (1131932). GP was supported with funding from NHMRC Project and Investigator Grants (GNT1099655 and GNT1173991), and the Research Council of Norway through its Centres of Excellence funding scheme (GNT262700).
Funding Information:
We would like to acknowledge Associate Investigator Heather D’Antoine for her guidance and governance for the First Nations data. In Queensland, we would like to thank the Linkages Services Branch at Queensland Health and Data Custodians for the Perinatal and Immunisation Data collections, and thank the Data Management team from the Royal Brisbane Women’s and Newborn Service for providing antenatal vaccination clinical audit data. In Western Australia, we would like to thank staff at the Linkage and Client Services Teams at the Data Linkage Branch, Department of Health Western Australia, as well as the Data Custodians for the Birth Registrations, Midwives Notification System, and WA Antenatal Vaccination Database. In the Northern Territory, we would like to thank Nicky O’Brien at SA-NT DataLink, Peter Markey, Heather Cook, and Vicki Krause at the NT Centre for Disease Control, and the Data Custodians for the NT Perinatal Trends and Immunisation Databases.
Publisher Copyright:
© 2023, The Author(s).
