National surveillance data analysis of COVID-19 vaccine uptake in England by women of reproductive age

Abstract

Women of reproductive age are a group of particular concern with regards to vaccine uptake, related to their unique considerations of menstruation, fertility, and pregnancy. To obtain vaccine uptake data specific to this group, we obtained vaccine surveillance data from the Office for National Statistics, linked with COVID-19 vaccination status from the National Immunisation Management Service, England, from 8 Dec 2020 to 15 Feb 2021; data from 13,128,525 such women at population-level, were clustered by age (18-29, 30-39, and 40-49 years), self-defined ethnicity (19 UK government categories), and index of multiple deprivation (IMD, geographically-defined IMD quintiles). Here we show that among women of reproductive age, older age, White ethnicity and being in the least-deprived index of multiple deprivation are each independently associated with higher vaccine uptake, for first and second doses; however, ethnicity exerts the strongest influence (and IMD the weakest). These findings should inform future vaccination public messaging and policy.

Fig. 1. COVID-19 vaccine uptake by age, normalised for date of vaccine availability by age group (thus, week 26 represents the week for universal age-tiered vaccination offer for all women of reproductive age groups).

The non-parametric Mood’s median test was used to compare the time to vaccination trajectories by age grouping; a two-sided P value was considered to be statistically significant was <0.001, corrected for multiple testing using the conservative Bonferroni correction (i.e., 5.38 × 10⁻⁶ for age); significance by week is represented by the coloured bar at the top of the Figures. The bars at the top of the figure represent the time periods during which there were significant differences in vaccine uptake by age, at the P < 5.38 × 10⁻⁶ level. Blue bars represent the first vaccination dose, and red bars second vaccination dose. It was not feasible to present 95% CI for vaccine uptake trajectories and maintain readability, but the statistical analyses accounted for trajectory variability within groups.

Fig. 2. COVID-19 vaccine uptate by ethnicity, normalised for date of vaccine avalablity by age.

COVID-19 first-dose vaccine uptake by ethnicity, normalised for date of vaccine availability by age group and presented for the first-dose by aggregated ethnic group (a) and by specific ethnic group (b). The “GRAND AVERAGE” represents the population average overall, presented as a reference for each graph. a Presents first-dose vaccine uptake by aggregated ethnic group, as in Supplementary Table 2; b presents first-dose vaccine uptake by specific ethnic group, as in Supplementary Table 2 with the exception of not stated/unknown which remains aggregated. The non-parametric Mood’s median test was used to compare the time to vaccination trajectories by ethnic group; a two-sided P value was considered to be statistically significant was <0.001, corrected for multiple testing using the conservative Bonferroni correction (i.e., 1.47 × 10⁻⁶ for ethnicity). Whilst it was not feasible to present 95% CI for vaccine uptake trajectories and maintain readability, the statistical analyses accounted for trajectory variability within groups. a The blue bars at the top of the figure represent the time periods during which there were significant differences in first-dose vaccine uptake by ethnicity, at the P < 1.47 × 10⁻⁶ level.

Fig. 3. COVID-19 vaccine uptake by the index of multiple deprivation, normalised for date of vaccine availability by age group.

The non-parametric Mood’s median test was used to compare the time to vaccination trajectories by IMD group; a two-sided P value was considered to be statistically significant was <0.001, corrected for multiple testing using the conservative Bonferroni correction (i.e., 3.23 × 10⁻⁶ for IMD). Whilst it was not feasible to present 95% CI for vaccine uptake trajectories and maintain readability, the statistical analyses accounted for trajectory variability within groups. The bars at the top of the figure represent time periods with significant differences in vaccine uptake by IMD, at the P < 3.23 × 10⁻⁶ level. Blue bars represent the first vaccination dose, and red bars second vaccination dose. Quintile 1 of the IMD represents the most deprived segment of the population. IMD (Index of Multiple Deprivation).

Fig. 4. Distribution across the strata of maternal age, ethnicity and IMD by the other characteristics.

a Distribution of ethnicity according to maternal age. b Distribution of IMD quintile by maternal age, with IMD 1 representing the most deprived quintile. c Distribution of ethnicity by IMD quintile.