COVID-19 vaccine equity: a retrospective population-based cohort study examining primary series and first booster coverage among persons with a history of immigration and other residents of Ontario, Canada

Frontiers in Public Health

Public Health

Pierre-Philippe Piché-Renaud¹  Janavi Shetty²  Julia Brandenberger³  Susitha Wanigaratne⁴  Astrid Guttmann⁵  Sima Gandhi⁶  Hong Lu⁶  Therese A. Stukel⁷  Samiya Abdi⁸ 

[1] Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada;Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, ON, Canada;Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, ON, Canada;Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada;Pediatric Emergency Department, University Hospital of Bern, Bern, Switzerland;Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada;ICES, Toronto, ON, Canada;ICES, Toronto, ON, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Public Health Ontario, Toronto, ON, Canada;

关键词: COVID-19 vaccine;    immigrants;    refugees;    public health;    Ontario (Canada);    social determinants of health;   

DOI  :  10.3389/fpubh.2023.1232507

 received in 2023-05-31, accepted in 2023-08-14,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionImmigrants 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.Materials and methodsUsing 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).ResultsOf 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).ConclusionTwo 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.

【 授权许可】

Unknown   
Copyright © 2023 Wanigaratne, Lu, Gandhi, Shetty, Stukel, Piché-Renaud, Brandenberger, Abdi and Guttmann.