(123) Racial and language disparities in initial COVID-19 vaccination during lactation

Background: Racial and ethnic disparities in COVID-19 vaccination during pregnancy have been well described; however, less is known about racial and language disparities in vaccine uptake during lactation.

Objectives: We examined associations between maternal race and ethnicity, primary language, and English proficiency and uptake of COVID-19 vaccination during lactation.

Methods: We used electronic health records (EHR) of patients aged 16-49 years from a health care system in Minnesota and Wisconsin. We selected patients that had a live birth between December 2020 and September 2022, were identified as ever breastfeeding according to infant or maternal records and had not received a COVID-19 vaccination before delivery. Patients were considered to be lactating until the last record indicating human milk feeding. Exposures were race and ethnicity; primary language; and limited English language proficiency (measured by need for interpreter during a medical encounter). Outcome was COVID-19 vaccination during lactation for up to 6 months as identified from EHR-based vaccine registries and state immunization systems. . We estimated rate ratios (RR) and 95% confidence intervals (CI) to evaluate disparities in vaccine uptake using Poisson regression models with breastfeeding duration as the offset and adjusting for calendar week of delivery. We compared the most reported race and ethnic groups, and primary languages.

Results: In total, 3,537 persons were eligible for COVID-19 vaccination during lactation. Vaccine uptake during lactation was 44% among eligible persons. Most of the cohort was non-Hispanic White (48.4%), followed by non-Hispanic Black (28.2%) and Asian (9%). The most common primary languages were English (89.4%), Somali (4.6%), Spanish (1%), and Oromo (1.1%), and approximately 7.5% of the cohort needed an interpreter. Compared to non-Hispanic White persons, non-Hispanic Black had a lower uptake of vaccination (RR 0.85, 95% CI 0.77-0.95), whereas non-Hispanic Asian (RR 1.79, 95% CI 1.59-2.02) and non-Hispanic with multiple races (RR 1.58, 95% CI 1.15-2.16) had higher vaccination rates. Persons whose primary language was Somali were less likely to be vaccinated (RR 0.59, 95% CI 0.45-0.77) while Spanish speakers were more likely to be vaccinated (RR 1.67, 95% CI 1.20-2.32), compared to English as primary language. The vaccine rates were similar between those who needed interpreters versus not.

Conclusions: In this cohort, disparities in COVID-19 vaccination during lactation were observed for those of non-Hispanic Black race, and Somali speakers. Our results call for attention in addressing disparities in COVID-19 vaccination uptake during lactation for those not vaccinated before delivery.