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

Bibliographic Data

ID22089737
AuthorsSusitha Wanigaratne (0000-0003-0840-9006, University of Toronto, corresponding author), Hong Lu (0000-0002-8529-441X), Sima Gandhi, Janavi Shetty (0000-0002-2925-1300, University of Toronto), Thérèse A Stukel (0000-0002-2951-1360, University of Toronto), Pierre‐Philippe Piché‐Renaud (0000-0003-4632-6877, Hospital for Sick Children), Pierre-Philippe Piché-Renaud, Julia Brandenberger (0000-0001-7169-8184, University of Toronto), Samiya Abdi (0000-0001-7520-7557, Public Health Ontario), Astrid Guttmann (0000-0001-8177-2253, University of Toronto)
Year2023
Volume11
Pages1232507-1232507
Publication date2023-09-08
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2023.1232507
PMID37744516
OpenAlexW4386542066
LanguageEN
Citations received3
References cited26

Introduction: 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. Materials and methods: 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). Results: 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). Conclusion: 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

Cohort · Cohort study · Disease · Environmental health · Family medicine · Geography · Immigration · Pandemic · Political science · Population · Retrospective cohort study · Sociology · Demography · Medicine · Migration, Health and Trauma · SARS-CoV-2 and COVID-19 Research · Vaccine Coverage and Hesitancy · Gerontology