(274) Language and racial disparities in initial COVID-19 vaccination during pregnancy

Background: Studies have reported racial and ethnic disparities in COVID-19 vaccination during pregnancy but there is knowledge gap on language disparities.

Objectives: To examine associations between preferred language, English proficiency, race and ethnicity, and uptake of COVID-19 vaccination during pregnancy.

Methods: We used electronic health records (EHR) of prenatal care patients aged 16-49 years from a health care system in Minnesota and Wisconsin. Patients were eligible for cohort entry if their pregnancy start dates were between August 2020 and November 2021 and if they had not received a COVID-19 vaccination prior to pregnancy. Exposures were primary language; limited English language proficiency, measured by need for interpreter during a medical encounter; and race and ethnicity. Outcome was COVID-19 vaccination during pregnancy. We identified COVID-19 vaccine administrations from EHR-based vaccine registries and state immunization systems. We compared vaccine uptake rates during pregnancy between the most frequent primary languages and race and ethnic groups and estimated the rate ratios (RR) and 95% confidence intervals (CI) using Poisson regression models. We included person time to end of pregnancy as the model offset and adjusted for calendar week of pregnancy start.

Results: The cohort consisted of 4,102 prenatal patients eligible for COVID-19 vaccination during pregnancy. Among eligible persons, COVID-19 vaccine uptake during pregnancy was 43%. The most common preferred languages were English (91.8%), Somali (3.2%); Spanish and Oromo speakers were 0.9% each. Nearly 6% of the cohort needed an interpreter. Non-Hispanic White (55%), non-Hispanic Black (22%) and non-Hispanic Asian (9%) were the most reported race and ethnic groups. COVID-19 vaccine uptake was lower among persons whose primary language was Somali (RR 0.49, 95% CI 0.35–0.68), compared with English language, and among those who needed an interpreter (RR 0.67, 95% CI 0.57–0.85) versus not. Compared with non-Hispanic White, other race and ethnic groups had lower rates of vaccination, especially non-Hispanic Black (RR 0.46, 95% CI 0.40-0.51); RRs were 0.69 (95% CI 0.59-0.81) for Hispanic, and 0.84 (95% CI 0.74-0.95) for Non-Hispanic Asian.

Conclusions: We observed disparities in COVID-19 vaccination during pregnancy for Somali speakers and those who need an interpreter in this cohort. Our study also showed disparities among racial and ethnic minority groups in COVID-19 vaccine during pregnancy. Efforts to increase COVID-19 vaccine equity during pregnancy could include focus on language-related and other barriers to care within these populations.