School of Public Health, Division of Medicine, University of Queensland, Brisbane, Qld, 4001, Australia.
Curtin School of Population Health, Curtin University, Perth, WA, Australia.
BMC Pregnancy Childbirth. 2023 May 8;23(1):314. doi: 10.1186/s12884-023-05574-w.
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.
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).
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).
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.
妊娠和婴儿早期是呼吸道感染导致严重不良后果的高危期。与非原住民女性和婴儿相比，澳大利亚的原住民和/或托雷斯海峡岛民（简称第一民族）女性和儿童患呼吸道疾病的负担更为沉重。为了预防这些感染，澳大利亚建议并免费为每位孕妇接种流感疫苗和百日咳（白喉）疫苗。我们旨在评估澳大利亚三个优先群体的流感和/或百日咳疫苗在妊娠期间的公平性：第一民族妇女；来自文化和语言多样化（CALD）背景的妇女；以及生活在偏远地区或社会经济劣势的妇女。
我们在 2012 年至 2017 年间对围产期数据收集与免疫登记/数据库进行了个体记录链接。分析包括广义线性混合模型，对数二项式回归，对唯一的产妇标识符进行随机截距，以考虑聚类，结果表示为患病率比（PR）和 95%置信区间（95%CI）。
最终队列中有 445,590 名个体女性。与其他澳大利亚女性（n=322,848）相比，第一民族女性（n=29,181）接受两种推荐的产前疫苗的可能性较小（PR 0.69，95%CI 0.67-0.71），而来自 CALD 背景的女性（n=93,561）接受疫苗的可能性较大（PR 1.16，95%CI 1.10-1.13）。生活在偏远地区的女性接受两种疫苗的可能性较小（PR 0.75，95%CI 0.72-0.78），而生活在最具优势地区的女性接受两种疫苗的可能性较大（PR 1.44，95%CI 1.40-1.48）。
与其他群体相比，澳大利亚原住民家庭、生活在偏远地区和/或社会经济背景较低的家庭在妊娠期间没有接种推荐的疫苗，而这些疫苗是公平医疗保健的基准。解决这些障碍必须仍然是澳大利亚医疗保健系统和疫苗提供者的核心优先事项。需要扩展这个队列，以重新评估这些研究结果。
