Disparities in Prenatal Immunization Rates in Rural and Urban US Areas by Indicators of Access to Care

Abstract

Purpose: To evaluate disparities in urban-rural immunization rates among pregnant women by indicators of access to health care. Methods:We analyzed Phase 8 (2016-2018) Pregnant Risk Assessment Monitoring System data for 82,603 respondents who recently gave birth to a live infant. Uptake of influenza (33 states) or Tdap (19 states) vaccines was compared for rural versus urban areas of participating states. We compared the prevalence of immunization for rural versus urban areas by indicators of health care access using average marginal predictive values from multivariable regression models.Findings: Although nearly half (48.2%) of pregnant women in rural areas relied on Medicaid to fund prenatal care, rural-residing women were less likely to live in a state offering full coverage under Medicaid to pregnant women than urban-residing women (93.9% vs 98.0%, respectively). Among states with Medicaid programs not offering full access for pregnant women, influenza immunization coverage was 12% lower (aPR 0.88; 95% CI 0.82, 0.94) and Tdap immunization coverage was 20% lower (aPR 0.80; 95% CI 0.68, 0.95) for rural versus urban areas. Uninsured women in rural areas were less likely to receive influenza or Tdap vaccine compared to uninsured women in urban areas (aPR 0.65; 95% CI 0.50, 0.85 and aPR 0.73; 95% CI 0.57, 0.95, respectively).Conclusions: Pregnant women residing in rural areas more commonly rely on Medicaid to financially support prenatal care but are less likely to have expanded or full access to Medicaid coverage, potentially contributing to disparities vaccine uptake during pregnancy and increased rates of vaccine-preventable disease.

Sociodemographic disparities in preterm birth and low birthweight in the State of Georgia: Results from the 2017‐2018 Pregnancy Risk Assessment Monitoring System

“…56,60 Notably, despite increased power, lack of selection during the imputation process moved some odds from statistically significant to nonsignificant in the multiply-imputed data (ie, the odds of LBW prevalence for the association with female infant sex and intermediate APNCU and the odds of term LBW prevalence for the association with smoking). 58,59 In general, in line with another study based on PRAMS data, 48 our study results from complete-case data analysis were similar to those from the multiply-imputed data analysis.…”

“…Several multiple imputation approaches are available. Another recently published study in this journal based on PRAMS data 48 used the weighted sequential hot deck imputation procedure. Our preferred approach was MICE, also known as fully conditional specification or sequential regression multiple imputation, because of its ability to tackle challenges arising from complex survey data and flexibility in determining imputation models 49–51 .…”

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study

“…Among states with programs that do not offer full access for pregnant women, influenza immunization coverage was 12% lower and Tdap (tetanus, diphtheria and pertussis) immunization coverage was 20% lower for rural versus urban areas. This shows the importance of a public health system that is accessible and equitable between regions (21) .…”

Assistência pré-natal associada aos desfechos neonatais em maternidades: estudo transversal de base hospitalar

“…Entre os Estados com programas que não oferecem acesso total para mulheres grávidas, a cobertura de imunização contra influenza foi 12% menor e a cobertura de imunização dTpa foi 20% menor para áreas rurais versus urbanas. Assim, percebe-se a importância do sistema de saúde público, acessível e equitativo entre as regiões (21) .…”