Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Front Public Health. 2023 Sep 8;11:1232507. doi: 10.3389/fpubh.2023.1232507. eCollection 2023.
Immigrants were disproportionately impacted by COVID-19 and experience unique vaccination barriers. In Canada (37 million people), 23% of the population is foreign-born. Immigrants constitute 60% of the country's racialized (non-white) population and over half of immigrants reside in Ontario, the country's most populous province. Ontario had several strategies aimed at improving vaccine equity including geographic targeting of vaccine supply and clinics, as well as numerous community-led efforts. Our objectives were to (1) compare primary series vaccine coverage after it was widely available, and first booster coverage 6 months after its availability, between immigrants and other Ontario residents and (2) identify subgroups experiencing low coverage.
Using linked immigration and health administrative data, we conducted a retrospective population-based cohort study including all community-dwelling adults in Ontario, Canada as of January 1, 2021. We compared primary series (two-dose) vaccine coverage by September 2021, and first booster (three-dose) coverage by March 2022 among immigrants and other Ontarians, and across sociodemographic and immigration characteristics. We used multivariable log-binomial regression to estimate adjusted risk ratios (aRR).
Of 11,844,221 adults, 22% were immigrants. By September 2021, 72.6% of immigrants received two doses (vs. 76.4%, other Ontarians) and by March 2022 46.1% received three doses (vs. 58.2%). Across characteristics, two-dose coverage was similar or slightly lower, while three-dose coverage was much lower, among immigrants compared to other Ontarians. Across neighborhood SARS-CoV-2 risk deciles, differences in two-dose coverage were smaller in higher risk deciles and larger in the lower risk deciles; with larger differences across all deciles for three-dose coverage. Compared to other Ontarians, immigrants from Central Africa had the lowest two-dose (aRR = 0.60 [95% CI 0.58-0.61]) and three-dose coverage (aRR = 0.36 [95% CI 0.34-0.37]) followed by Eastern Europeans and Caribbeans, while Southeast Asians were more likely to receive both doses. Compared to economic immigrants, resettled refugees and successful asylum-claimants had the lowest three-dose coverage (aRR = 0.68 [95% CI 0.68-0.68] and aRR = 0.78 [95% CI 0.77-0.78], respectively).
Two dose coverage was more equitable than 3. Differences by immigrant region of birth were substantial. Community-engaged approaches should be re-invigorated to close gaps and promote the bivalent booster.
移民受到 COVID-19 的不成比例影响，并面临独特的疫苗接种障碍。在加拿大（3700 万人），23%的人口是外国出生的。移民构成了该国（非白人）种族化人口的 60%，超过一半的移民居住在安大略省，这是加拿大人口最多的省份。安大略省采取了几项旨在改善疫苗公平性的战略，包括疫苗供应和诊所的地理定位，以及众多社区主导的努力。我们的目标是：(1) 比较广泛可用后的初级系列疫苗接种覆盖率，以及首次加强针接种覆盖率在其供应后 6 个月，比较移民和其他安大略省居民；(2) 确定覆盖率较低的亚组。
使用链接的移民和健康行政数据，我们开展了一项回顾性基于人群的队列研究，包括截至 2021 年 1 月 1 日安大略省的所有社区居住成年人。我们比较了 2021 年 9 月之前的初级系列（两剂）疫苗接种覆盖率，以及 2022 年 3 月之前的首次加强针（三剂）接种覆盖率，比较了移民和其他安大略省居民之间，以及社会人口学和移民特征之间的情况。我们使用多变量对数二项式回归来估计调整后的风险比 (aRR)。
在 11844221 名成年人中，22%是移民。到 2021 年 9 月，72.6%的移民接种了两剂疫苗（其他安大略省为 76.4%），到 2022 年 3 月，46.1%的移民接种了三剂疫苗（其他安大略省为 58.2%）。在所有特征中，与其他安大略省居民相比，移民的两剂疫苗接种覆盖率相似或略低，而三剂疫苗接种覆盖率则低得多。在所有邻里 SARS-CoV-2 风险十分位数中，两剂疫苗接种覆盖率的差异在风险较高的十分位数中较小，在风险较低的十分位数中较大；所有十分位数的三剂疫苗接种覆盖率差异都较大。与其他安大略省居民相比，来自中非的移民两剂和三剂疫苗接种覆盖率最低（aRR=0.60[95%CI0.58-0.61]和 aRR=0.36[95%CI0.34-0.37]），其次是东欧人和加勒比人，而东南亚人更有可能接种两剂疫苗。与经济移民相比，重新安置的难民和成功的庇护申请者的三剂疫苗接种覆盖率最低（aRR=0.68[95%CI0.68-0.68]和 aRR=0.78[95%CI0.77-0.78]）。
两剂疫苗接种覆盖率比三剂更公平。移民出生地区的差异很大。应该重新激发社区参与的方法，以缩小差距并推广双价加强针。
