Transportation insecurity lowers flu vaccination in pregnant individuals

Transportation insecurity lowers flu vaccination in pregnant individuals | Image Credit: © Azeemud-Deen Jacobs/peopleimages.com - © Azeemud-Deen Jacobs/peopleimages.com - stock.adobe.com.

There is a link between transportation insecurity (TI) and reduced influenza vaccination among pregnant individuals, according to a recent study presented at the Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting.¹

Despite clinical recommendations to receive influenza vaccination during pregnancy to reduce health care costs and improve health outcomes, a reduction in influenza vaccine administration has been observed, from 61% in 2019 to 47% in 2022. Additionally, significant racial and ethnic disparities in influenza vaccination have been reported.

Maternal influenza vaccination has been linked to reduced rates of infant influenza and associated hospitalization.² When evaluating influenza rates within the first 6 months of life through polymerase chain reaction, one study reported a positive test in 26.8% of the vaccination group vs 35.6% of the nonvaccination group.

TI is defined as being unable to access safe and reliable transportation.¹ This prevents individuals from reaching a desired location, including places such as an ob-gyn office where influenza vaccination may be offered. In the 2021 to 2022 season, ob-gyn offices were the top location where pregnant patients received an influenza vaccine.

Investigators conducted a study to evaluate the impact of TI on influenza vaccination among pregnant patients. Data about US pregnant individuals in 2022 was obtained from a publicly available national telephone survey for use in the analysis.

The behavioral risk factors surveillance system survey was conducted across 42 US states and territories in 2022 and included 1428 pregnant individuals who were disproportionately stratified. TI was defined as the primary exposure of the analysis and influenza vaccination as the primary outcome.

Younger patients were more likely to experience TI, at a rate of 16.1% in those aged 18 to 24 years vs 10.9% in those aged 25 to 34 years and 10.8% in those aged 35 years and older. Urban status was also associated with increased TI than rural status, at 12.7% vs 8.9%, respectively.

Significant racial and ethnic disparities were observed, with TI reported in 20.5% of Black patients vs 8.6% of White patients, as well as 10.4% of Hispanic patients and 11.5% of Asian patients. Insurance was also a significant factor, with 29% of uninsured patients having TI.

For insurance types, government sponsored insurance was linked to a TI rate of 15.3% vs 12.9% for individual private plan and 2.9% for employer sponsored insurance. Additionally household annual income influenced TI. A household annual income of under $25,000 was linked to a 22.6% TI rate, vs only 1.3% for $50,000 or more.

The prevalence of influenza vaccination was also stratified by household annual income. Rates were 23.9% for under $25,000 and 50.2% for at least $50,000. For patients with a household annual income of $25,000 to $49,999, the rates of TI and influenza vaccination were 18.6% and 30.6%, respectively.

Overall, influenza vaccination within the past 12 months was reported among 40.7% of respondents who were transportation secure vs 16.3% with TI. The unadjusted odds ratio (OR) for influenza vaccination among patients with TI was 0.28, indicating a 72% reduced odds of vaccination vs those without TI. After adjustment, this OR was 0.49.

These results indicated reduced influenza vaccination among pregnant patients with TI vs those without TI, with this link attenuated when adjusting for income, race, and type of health insurance. Investigators recommended evaluating the impact of interventions that expand prenatal care access.

Reference

1. Pinkney JA, Bogart LM, Shebl FM, et al. The relationship between influenza vaccination and transportation insecurity among pregnant individuals in the United States. Presented at: The Infectious Disease Society for Obstetrics and Gynecology 2024 Annual Meeting. Portland, OR. August 1-3, 2024.
2. Krewson C. Maternal influenza vaccination during pregnancy protects infants. November 30, 2022. Accessed August 6, 2024. https://www.contemporaryobgyn.net/view/maternal-influenza-vaccination-during-pregnancy-protects-infants