Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
Am J Obstet Gynecol MFM. 2023 Aug;5(8):101007. doi: 10.1016/j.ajogmf.2023.101007. Epub 2023 May 6.
Political affiliation has been associated with vaccine uptake, but whether this association holds in pregnancy, when individuals are recommended to receive multiple vaccinations, remains to be studied.
This study aimed to examine the association between community-level political affiliation and vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in pregnant and postpartum individuals.
A survey was conducted about tetanus, diphtheria, and pertussis and influenza vaccinations in early 2021, with a follow-up survey of COVID-19 vaccination among the same individuals at a tertiary care academic medical center in the Midwest. Geocoded residential addresses were linked at the census tract to the Environmental Systems Research Institute 2021 Market Potential Index, which ranks a community in comparison to the US national average. The exposure for this analysis was community-level political affiliation, defined by the Market Potential Index as very conservative, somewhat conservative, centrist, somewhat liberal, and very liberal (reference). The outcomes were self-reported vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in the peripartum period. Modified Poisson regression was used and adjusted for age, employment, trimester at assessment, and medical comorbidities.
Of 438 assessed individuals, 37% lived in a community characterized by very liberal political affiliation, 11% as somewhat liberal, 18% as centrist, 12% as somewhat conservative, and 21% as very conservative. Overall, 72% and 58% of individuals reported receiving tetanus, diphtheria, and pertussis and influenza vaccinations, respectively. Of the 279 individuals who responded to the follow-up survey, 53% reported receiving COVID-19 vaccination. Individuals living in a community characterized by very conservative political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (64% vs 72%; adjusted risk ratio, 0.83; 95% confidence interval, 0.69-0.99); influenza (49% vs 58%; adjusted risk ratio, 0.79; 95% confidence interval, 0.62-1.00); and COVID-19 (35% vs 53%; adjusted risk ratio, 0.65; 95% confidence interval, 0.44-0.96) than those in a community characterized by very liberal political affiliation. Individuals living in a community characterized by centrist political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (63% vs 72%; adjusted risk ratio, 0.82; 95% confidence interval, 0.68-0.99) and influenza (44% vs 58%; adjusted risk ratio, 0.70; 95% confidence interval, 0.54-0.92) than those in a community characterized by very liberal political affiliation.
Compared with pregnant and postpartum individuals living in communities characterized by very liberal political beliefs, those living in communities characterized by very conservative political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19, and those in communities characterized by centrist political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis and influenza. Increasing vaccine uptake in the peripartum period may need to consider engaging an individual's broader sociopolitical milieu.
政治派别与疫苗接种率有关，但在个人被建议接种多种疫苗的怀孕期间，这种关联是否存在，仍有待研究。
本研究旨在研究社区层面的政治派别与破伤风、白喉和百日咳；流感；以及 COVID-19 在孕妇和产后个体中的疫苗接种率之间的关系。
在 2021 年初进行了关于破伤风、白喉和百日咳以及流感疫苗接种的调查，并在中西部一家三级保健学术医疗中心对同一人群进行了 COVID-19 疫苗接种的后续调查。将居住地址进行地理编码，并与环境系统研究所 2021 年市场潜力指数相链接，该指数根据社区与美国全国平均水平的比较对社区进行排名。本分析的暴露因素是社区层面的政治派别，由市场潜力指数定义为非常保守、有点保守、中间派、有点自由和非常自由（参考）。结果是在围产期自我报告的破伤风、白喉和百日咳；流感；以及 COVID-19 疫苗接种。采用修正泊松回归，并调整了年龄、就业、评估时的妊娠分期和合并症。
在评估的 438 名个体中，37%的人生活在政治派别非常自由的社区，11%的人生活在有点自由的社区，18%的人生活在中间派社区，12%的人生活在有点保守的社区，21%的人生活在非常保守的社区。总体而言，分别有 72%和 58%的个体报告接种了破伤风、白喉和百日咳以及流感疫苗。在 279 名回答后续调查的个体中，53%的人报告接种了 COVID-19 疫苗。生活在政治派别非常保守的社区的个体报告接种破伤风、白喉和百日咳的可能性较低（64%比 72%；调整后的风险比，0.83；95%置信区间，0.69-0.99）；流感（49%比 58%；调整后的风险比，0.79；95%置信区间，0.62-1.00）和 COVID-19（35%比 53%；调整后的风险比，0.65；95%置信区间，0.44-0.96）比生活在政治派别非常自由的社区的个体。生活在中间派政治派别的社区的个体报告接种破伤风、白喉和百日咳的可能性较低（63%比 72%；调整后的风险比，0.82；95%置信区间，0.68-0.99）和流感（44%比 58%；调整后的风险比，0.70；95%置信区间，0.54-0.92）比生活在政治派别非常自由的社区的个体。
与生活在政治信仰非常自由的社区的孕妇和产后个体相比，生活在政治信仰非常保守的社区的个体报告接种破伤风、白喉和百日咳；流感；和 COVID-19 的可能性较低，生活在中间派政治信仰的社区的个体报告接种破伤风、白喉和百日咳和流感的可能性较低。在围产期增加疫苗接种率可能需要考虑到个体更广泛的社会政治环境。
