Examining vaccine coverage among immigrant populations in Alberta, Canada and factors associated with vaccination

• Author / Creator

  Du, Crystal J

• Study 1: Human papillomavirus vaccine coverage among immigrant children in Alberta: a population-based cohort study
  Background: Previous studies have shown that parents of immigrant children have more negative perceptions about human papillomavirus (HPV) vaccine than parents of non-immigrant children. However, there is a lack of studies measuring HPV vaccine coverage amongst school-aged immigrant children in Canada. Therefore, the objective of this study was to assess HPV vaccine coverage and factors associated with uptake among foreign-born immigrant children relative to the non-immigrant population in Alberta, Canada.
  Methods: In this cohort study, we analyzed population-based linked administrative health data to measure HPV vaccine coverage for 346,749 school-aged children in Alberta, Canada, of which 31,656 were immigrants. Coverage was examined at 12 years old for the years 2014 to 2018; vaccine series completion was considered receipt of 3 doses during this period. We used multivariable logistic regression to examine the association of vaccine coverage with migration status, adjusting for socio-demographic variables. Difference in coverage between age 12 and 17 was also analyzed in females from the years 2008 to 2013.
  Findings: Since the start of the program in 2008 until 2018, HPV vaccination coverage (receipt of 3 doses) among immigrant children was significantly higher (52.58%) in comparison to non-immigrant children (47.41%). When excluding the first two years of program implementation for each sex, combined HPV vaccination coverage was 58.14% (95% CI 57.64, 58.63) among immigrants and 54.95% (95% CI 54.78, 55.11) among non-immigrants. Immigrants from Asia and Africa had the highest coverage (57.09 – 64.14%), while immigrants from North America, Oceania, and South America had the lowest coverage (38.30 – 44.96%). A multivariable logistic regression model analyzing data from 2014 to 2018 found vaccine coverage was relatively similar across income quintiles; however, immigrants living in rural residences had lower vaccine coverage in comparison to non-immigrants (39. 76% vs 45.05%). When comparing vaccine coverage at age 12 to age 17 in only females (from 2008 to 2013), the total increase was insignificant between immigrant (30.93%) and non-immigrants (31.96%).
  Conclusion: Overall, immigrant children had higher HPV vaccination coverage in comparison to non-immigrants, which is encouraging given some previous literature has suggested the opposite. This implies that efforts to increase vaccination rates among immigrant children may be having a positive impact. Among immigrants, routine immunization promotion strategies should be targeted to those living in rural residences and from North America, Oceania, and South America, in order to improve HPV vaccination coverage in this group even further.
  Study 2: COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study
  Background Studies have shown that immigrants often have lower vaccination rates than the Canadian-born population. We sought to assess COVID-19 vaccine coverage and factors associated with uptake among foreign-born immigrants relative to the non-immigrant population in Alberta, Canada.
  Method: In this cross-sectional study, we analyzed population-based linked administrative health data from Alberta to examine vaccine coverage for 3,931,698 Albertans, of which 731,217 were immigrants. We calculated COVID-19 vaccination coverage as the proportion of eligible Albertans with a record of receiving at least one dose of a COVID-19 vaccine as of November 29, 2021. We used multivariable logistic regression to examine the association of vaccine coverage with migration status (immigrants: four categories based on time since migration and non-immigrants) adjusting for socio-demographic variables.
  Results Overall, COVID-19 vaccination coverage was 78.2% (95% CI: 78.1%-78.3%) among immigrants and 76.0% (95% CI: 75.9%-76.0%) among non-immigrants. Coverage among immigrants differed by continent of origin, with North America, Oceania, and Europe having the lowest coverage. Although vaccine coverage was relatively uniform across neighborhood income quintiles for immigrants, immigrants living in rural areas had lower vaccine coverage compared to non-immigrants living in rural areas. Multivariable logistic regression analysis showed a significant interaction between age category and migration status. While immigrants below 50 years of age generally had significantly higher vaccine coverage compared to non-immigrants, there was some variation based on time since migration. Immigrants above 50 years of age showed significantly lower coverage compared to non-immigrants of the same age.
  Conclusions In conclusion, high COVID-19 vaccination coverage among immigrant populations is an encouraging outcome. However, continued efforts are needed to target public health interventions towards older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.

• Subjects / Keywords

  • vaccination
  • immigrants
  • immunization
  • Alberta
  • Canada
  • COVID-19
  • HPV

• Graduation date

  Spring 2023

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-mabm-b992

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.