• Matthew F Daley, Liza M Reifler, Jo Ann Shoup, Jason M Glanz, Allison L Naleway, Jennifer C Nelson, WilliamsJoshua T BJTBDepartment of General Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA. Electronic address: joshua.williams@dhha.org., Huong Q McLean, Gabriela Vazquez-Benitez, Kristin Goddard, Bruno J Lewin, Eric S Weintraub, Michael M McNeil, Hilda Razzaghi, and James A Singleton.
• Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: matthew.f.daley@kp.org.
• Prev Med. 2023 Dec 1; 177: 107751107751.

ObjectiveRacial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States have been documented. This study assessed the contribution of vaccine-related attitudes to coverage disparities.MethodsSurveys were conducted following the 2019-2020 and 2020-2021 influenza seasons in a US research network. Using electronic health record data to identify pregnant women, random samples were selected for surveying; non-Hispanic Black women and influenza-unvaccinated women were oversampled. Regression-based decomposition analyses were used to assess the contribution of vaccine-related attitudes to racial and ethnic differences in influenza vaccination. Data were combined across survey years, and analyses were weighted and accounted for survey design.ResultsSurvey response rate was 41.2% (721 of 1748) for 2019-2020 and 39.3% (706 of 1798) for 2020-2021. Self-reported influenza vaccination was higher among non-Hispanic White respondents (79.4% coverage, 95% CI 73.1%-85.7%) than Hispanic (66.2% coverage, 95% CI 52.5%-79.9%) and non-Hispanic Black (55.8% coverage, 95% CI 50.2%-61.4%) respondents. For all racial and ethnic groups, a high proportion (generally >80%) reported being seen for care, recommended for influenza vaccination, and offered vaccination. In decomposition analyses, vaccine-related attitudes (e.g., worry about vaccination causing influenza; concern about vaccine safety and effectiveness) explained a statistically significant portion of the observed racial and ethnic disparities in vaccination. Maternal age, education, and health status were not significant contributors after controlling for vaccine-related attitudes.ConclusionsIn a setting with relatively high influenza vaccination coverage among pregnant women, racial and ethnic disparities in coverage were identified. Vaccine-related attitudes were associated with the disparities observed.Copyright © 2023 Elsevier Inc. All rights reserved.

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