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Background
Covid-19 vaccination is the main strategy to reduce SARS-CoV-2 transmission, mortality and morbidity. This study aimed to examine sociodemographic differences in Covid-19 vaccine uptake among all individuals invited for Covid-19 vaccination in Denmark.
Methods
This study was designed as a nationwide register-based cohort study. The stud...
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Introduction
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Citations
... Large disparities have been observed in the uptake of COVID-19 vaccines both between countries, [8,9] but also within countries [9]. The withincountries disparities have among others been related to demographic, social, or economic differences [10][11][12][13][14][15][16][17][18][19]. Various approaches, based on aggregated data, [13,17] on individual data from surveys, [15,20] or on individual data from health registers, [10,12,14,18,19] generally lead towards the same conclusions that lower socio-economic statuses and specific demographic situations (young age groups, people with a migration background) are associated with lower COVID-19 vaccine uptake. ...
Vaccination has played a major role in overcoming the COVID-19 pandemic. However, vaccination status can be influenced by demographic and socio-economic factors at individual and area level.
In the context of the LINK-VACC project, the Belgian vaccine register for the COVID-19 vaccination campaign was linked at individual level with other registers, notably the COVID-19 laboratory test results and demographic and socio-economic variables from the DEMOBEL database. The present article aims at investigating to which extent COVID-19 vaccination status is associated with area level and/or individual level demographic and socio-economic factors. From a sample of all individuals tested for SARS-CoV-2 (LINK-VACC sample) demographic and socio-economic indicators are derived and their impact on vaccination coverages at an aggregated geographical level (municipality) is quantified. The same indicators are calculated for the full Belgian population, allowing to assess the representativeness of the LINK-VACC sample with respect to the impact of demographic and socio-economic disparities on vaccination uptake.
In a second step, hierarchical models are fitted to the individual level LINK-VACC data to disentangle the individual and municipality effects allowing to evaluate the added value of the availability of individual level data in this context.
The most important effects observed at the individual level are reflected in the aggregated data at the municipality level. Multilevel analyses show that most of the demographic and socio-economic impacts on vaccination are captured at the individual level, although accounting for area level in individual level analyses improve the overall description.
... Specifically, five of these were carried out in Norway, two each in France, Germany, and Italy, one each in Finland, Denmark, Sweden, and Turkey, and one multicentric study in Switzerland, France, and Italy. Three studies (19%) were published in 2021 [23,25,29], four (25%) in 2023 [16,18,21,30], and the remaining nine studies (56%) in 2022 [17,[19][20][21][22]24,[26][27][28]. The earliest data collection was compiled in the period May 2020-June 2020 in Longchamps' study [25], which investigated the hesitancy to vaccinate, as the COVID-19 vaccine was not yet available; the latest one was compiled on COVID-19 vaccination status in February, March, and May 2022 by Aysit et al. [16]. ...
... Specifically, five of these were carried out in Norway, two each in France, Germany, and Italy, one each in Finland, Denmark, Sweden, and Turkey, and one multicentric study in Switzerland, France, and Italy. Three studies (19%) were published in 2021 [23,25,29], four (25%) in 2023 [16,18,21,30], and the remaining nine studies (56%) in 2022 [17,[19][20][21][22]24,[26][27][28]. The earliest data collection was compiled in the period May 2020-June 2020 in Longchamps' study [25], which investigated the hesitancy to vaccinate, as the COVID-19 vaccine was not yet available; the latest one was compiled on COVID-19 vaccination status in February, March, and May 2022 by Aysit et al. [16]. ...
... Immigrant samples consisted of participants of both sexes in all studies. Sample sizes ranged from 204 participants (a convenience sample of immigrants in Germany) [20] in the smallest to over five million (individual-based data from nationwide Danish registries) [21] in the largest. ...
Vaccination plays a pivotal role in the control of infectious disease outbreaks. Hesitancy/refusal of the vaccine by immigrants poses a serious threat to their and society’s health. We reviewed studies regarding COVID-19 vaccine uptake in Europe by first-generation immigrants. A systematic review (PROSPERO: CRD42023432142), conducted until 31 October 2023 using Web of Science, PubMed, and Scopus, identified 295 potential articles. Of these, 16 conducted on 2,009,820 immigrants in nine European countries met the eligibility criteria. Most studies were of medium/high quality according to the Newcastle–Ottawa Scale adapted for observational studies. Factors that affected the uptake or hesitancy/refusal to vaccinate, with particular regard to gender, age, and country of origin, were examined. The meta-analysis of eight studies revealed that the pooled estimated prevalence of COVID-19 vaccine uptake in first-generation immigrants was 71.3% (95% CI: 70.0–72.5%), corresponding to 13.3% less than the host country population (95% CI: 10.2–16.4%). Limitations of included studies and this review were deeply discussed, highlighting the need for further research on the effect of acculturation on second-generation immigrants. European governments need to ensure equal availability of COVID-19 and other health-saving vaccines to all immigrants in the future by overcoming cultural barriers, building trust in institutions, and improving communication.
... However, this reflects the reality of studying COVID-19 vaccine safety in countries where the majority of the adult population has completed the primary course. Further participation bias may be of concern, as never having taken a PCR test for SARS-CoV-2 is associated with being unvaccinated in Denmark 16 , and invitations to the survey hinged on testing. We also did not examine symptoms following booster vaccination, as the timing of booster rollout and wide-spread infections with the Omicron variant overlapped during winter 2022. ...
Many individuals who refuse COVID-19 vaccination have concerns about long-term side effects. Here, we report findings on self-reported symptoms from a Danish survey- and register study. The study included 34,868 vaccinated primary course recipients, 95.8% of whom received mRNA vaccines, and 1,568 unvaccinated individuals. Participants had no known history of SARS-CoV-2 infection. Using g-computation on logistic regression, risk differences (RDs) for symptoms between vaccinated and unvaccinated persons were estimated with adjustments for possible confounders. Within six weeks after vaccination, higher risks were observed for physical exhaustion (RD 4.9%, 95% CI 1.1% to 8.4%), fever or chills (RD 4.4%, 95% CI 2.1% to 6.7%), and muscle/joint pain (RD 7.0%, 95% CI 3.1% to 10.7%), compared to unvaccinated individuals. Beyond twenty-six weeks, risks were higher among the vaccinated for sleeping problems (RD 3.0, 95% 0.2 to 5.8), fever or chills (RD 2.0, 95% CI 0.4 to 3.6), reduced/altered taste (RD 1.2, 95% CI 0.2 to 2.3) and shortness of breath (RD 2.6, 95% CI 0.9 to 4.0). However, when examining pre-omicron responses only, the difference for reduced/altered taste was significant. As expected, the risk of experiencing physical exhaustion, fever or chills, and muscle/joint pain was higher among persons who responded within six weeks of completing the primary course. No significant differences were observed for the 7-25-week period after vaccination. Associations for the period beyond 26 weeks must be interpreted with caution and in the context of undetected SARS-CoV-2 infection, wide confidence intervals, and multiple testing. Overall, we observe no concerning signs of long-term self-reported physical, cognitive, or fatigue symptoms after vaccination.
... Despite universal healthcare coverage, socioeconomic differences in COVID-19 vaccine uptake were observed in Denmark. In a registry-based study of COVID-19 vaccination coverage in Denmark, Gram et al. [36] found that among those with the highest odds of non-vaccination were descendants of non-Western immigrants and those with primary school as their highest completed level of education-two indicators of lower SES in Denmark-but also those with high disposable incomesan indicator of high SES. However, those of high SES in Denmark were most likely protected against increased levels of COVID-19 mortality due to other social factors. ...
... Age-specific contributions of mortality from causes other than COVID-19 deviated from the pre-pandemic patterns in 2020 but mostly bounced back in 2021. This could be because of the occupations that women in this income group have, with a higher share of essential workers than in the other groups, who were at higher risk of mortality in 2020 but lower in 2021 due to early vaccinations [36,39]. Furthermore, men in the third income quartile experienced a large decrease in life expectancy when compared to prepandemic levels in 2020, followed by an increase in 2021. ...
Background
Denmark was one of the few countries that experienced an increase in life expectancy in 2020, and one of the few to see a decrease in 2021. Because COVID-19 mortality is associated with socioeconomic status (SES), we hypothesize that certain subgroups of the Danish population experienced changes in life expectancy in 2020 and 2021 that differed from the country overall. We aim to quantify life expectancy in Denmark in 2020 and 2021 by SES and compare this to recent trends in life expectancy (2014–2019).
Methods
We used Danish registry data from 2014 to 2021 for all individuals aged 30+. We classified the study population into SES groups using income quartiles and calculated life expectancy at age 30 by year, sex, and SES, and the differences in life expectancy from 2019 to 2020 and 2020 to 2021. We compared these changes to the average 1-year changes from 2014 to 2019 with 95% confidence intervals. Lastly, we decomposed these changes by age and cause of death distinguishing seven causes, including COVID-19, and a residual category.
Results
We observed a mortality gradient in life expectancy changes across SES groups in both pandemic years. Among women, those of higher SES experienced a larger increase in life expectancy in 2020 and a smaller decrease in 2021 compared to those of lower SES. Among men, those of higher SES experienced an increase in life expectancy in both 2020 and 2021, while those of lower SES experienced a decrease in 2021. The impact of COVID-19 mortality on changes in life expectancy in 2020 was counterbalanced by improvements in non-COVID-19 mortality, especially driven by cancer and cardiovascular mortality. However, in 2021, non-COVID-19 mortality contributed negatively even for causes as cardiovascular mortality that has generally a positive impact on life expectancy changes, resulting in declines for most SES groups.
Conclusions
COVID-19 mortality disproportionally affected those of lower SES and exacerbated existing social inequalities in Denmark. We conclude that in health emergencies, particular attention should be paid to those who are least socially advantaged to avoid widening the already existing mortality gap with those of higher SES. This research contributes to the discussion on social inequalities in mortality in high-income countries.
... For example, in a study conducted over 24 million adults in England, the first dose of COVID-19 vaccination was lower among all ethnic minority groups compared with white British adults 18 . Another study conducted in Denmark over 4.9 million individuals aged 12 years or more in 2021 found that non-vaccination was most pronounced among migrants or descendants 19 . In contrast, a study conducted in Switzerland did not find an association between Swiss-born and foreign-born individuals 20 . ...
Migrants may be susceptible to vaccine barriers and hesitancy. We evaluated the association between migrant status, as measured by the citizenship from a High Migratory Pressure Country (HMPC), and COVID-19 vaccination uptake in the resident population in Rome, Italy. We also investigated sex differences. We followed participants for vaccination against COVID-19 in 2021. We calculated crude- and adjusted-vaccination rates and Cox hazard ratios of vaccination for migrants compared to Italians. Among migrants from HMPCs, we estimated HRs for females compared to males, stratifying by geographical area of origin. Models were adjusted for age and deprivation index and stratified by infection history. In 2021, among 1,731,832 18–64-year-olds, migrants were 55% less likely to uptake at least one COVID-19 vaccine dose than their Italian counterpart. Past SARS-CoV-2 infection reduced the difference between migrants and Italians to 27%. Among migrants from HMPCs, we observed a slight excess of vaccination uptake among females compared to males. Focusing on geographical areas, we observed that only females from central-western Asia were 9% less likely to uptake vaccination than males. Health communication strategies oriented to migrants and considering their different languages, cultures, and health literacy should be adopted for prevention before emergencies.
... We identified only few articles that described registry-based studies examining the association between socio-demographic and economic factors, and COVID-19 (booster) vaccination. These studies showed a higher vaccine uptake among older individuals, females and those without prior COVID-19 infection while lower uptake was observed among socially deprived individuals and those with a migrant background [11][12][13][14][15][16]. Even though several studies looked into previous COVID-19 infection, none of the aforementioned studies have examined the potential impact of both frequency and timing of individual COVID-19 infections on booster uptake, specifically [3,6,[9][10][11]16]. ...
... These studies showed a higher vaccine uptake among older individuals, females and those without prior COVID-19 infection while lower uptake was observed among socially deprived individuals and those with a migrant background [11][12][13][14][15][16]. Even though several studies looked into previous COVID-19 infection, none of the aforementioned studies have examined the potential impact of both frequency and timing of individual COVID-19 infections on booster uptake, specifically [3,6,[9][10][11]16]. ...
... Our database does not contain any perception data, hence we cannot link observational data with opinionated data. Thirdly, our model included basic demographic factors and infection history as predictors, but other individual-level factors can influence booster uptake as well, as shown in other studies [11][12][13][14]16]. Variables such as household income, migration background, level of social deprivation, profession (healthcare or non-healthcare) and underlying illnesses, will be considered in future analyses to provide a more comprehensive understanding of booster uptake. ...
Objective
This study aimed to investigate factors influencing the uptake of first and second COVID-19 booster vaccines among adults in Belgium, particularly age, sex, region of residence and laboratory confirmed COVID-19 infection history.
Results
A binomial regression model was used with having received the first or second booster as outcome and age, sex, region of residence and infection history as fixed variables. Among adults, there was generally a higher uptake to receive the first booster among older age groups compared to younger ones. Females, individuals residing in Flanders and those with no previous COVID-19 infection were more likely to receive the first booster. For the second booster, the same age trend was seen as for the first booster. Males, individuals residing in Flanders and those who tested positive for COVID-19 once after first booster were more likely to receive the second booster. Individuals with multiple positive COVID-19 tests before and after primary course or first booster were less likely to receive the subsequent booster dose compared to COVID-naïve individuals. This information could be used to guide future vaccination campaigns during a pandemic and can provide valuable insights into booster uptake patterns.
Vaccination is an evidence-based strategy to prevent or reduce the severity of infectious diseases (ID). Here, we aimed to describe the experience of implementing a vaccination clinic specifically targeting liver, heart, lung, and combined dual organ transplantation at a single transplantation center in Denmark. In this cohort of 242 solid organ transplant (SOT) candidates, we investigated seroprotection and the proportion of recommended vaccinations documented before transplantation. Furthermore, we registered completed vaccinations after ID consultations. The median age in our cohort was 53 years (IQR, 42–60), 60% were males (n = 135), and liver transplants (n = 138; 57%) were the most frequently planned organ transplants. Before the consultation to the vaccination clinic, influenza and pneumococcal vaccines had the highest proportion of documented vaccination (58% and 37%, respectively). Serological protection was more frequently observed for measles, mumps, or rubella (MMR, approximately 90% for each), while only 30% (n = 72) of SOT candidates showed seroprotection against pneumococcal disease. All SOT candidates required at least one of the recommended vaccines, and over 90% required three or more. At least 10% of patients in our cohort needed a live attenuated vaccine for either MMR or yellow fever. The most frequently administered vaccine was the tetanus–diphtheria-acelullar pertussis (Tdap) booster (n = 217; 90%), influenza vaccination was either administered (n = 16; 7%) or recommended (n = 226; 93%), PCV13 was administered (n = 155; 64%) or recommended (n = 27; 11%), and PPSV23 was either administered (n = 18; 7.4%) or recommended (n = 140; 58%). All SOT candidates adhered completely to their vaccination schedules. Based on our findings, we recommend prioritizing vaccination before transplantation by providing ID consultations for SOT candidates.
Background: In most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark.
Methods: The study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016-2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of mammography screening participation within 90, 180 and 365 days since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation.
Results: The study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 days, 82.7% within 180 days and 83.1% within 365 days. At the start of the pandemic, the participation in screening within 90 days was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in 1 st lockdown. Extending the length of follow-up time to 365 days only a minor overall reduction was observed (PR=0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR=0.97; 95% CI: 0.96-0.97 in 1 st lockdown). A lower participation was; however, seen among immigrants and among women with a low income.
Conclusions: The short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time indicating that women postponed screening. Some groups of women; nonetheless, had a lower participation indicating that the social inequity in screening participation was exacerbated during the pandemic.
Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
Background:
There is limited information about sociodemographic disparities in COVID-19 vaccine uptake among non-elderly adults with increased risk of severe COVID-19. We investigated the COVID-19 vaccine uptake in individuals aged 18 to 64 years with increased risk of severe COVID-19 (non-elderly risk group) in Stockholm County, Sweden.
Method:
We used population-based health and sociodemographic registries with high coverage to perform a cohort study of COVID-19 vaccine uptake of one to four doses up until 21 November 2022. The vaccine uptake in the non-elderly risk group was compared with non-risk groups aged 18 to 64 years (non-elderly non-risk group) and individuals aged ≥65 years (elderly).
Results:
The uptake of ≥3 vaccine doses was 55%, 64%, and 87% in the non-elderly non-risk group (n = 1,005,182), non-elderly risk group (n = 308,904), and elderly (n = 422,604), respectively. Among non-elderly risk group conditions, Down syndrome showed the strongest positive association with receiving three doses (adjusted risk ratio [aRR] 1.62, 95% confidence interval [CI] 1.54-1.71), whereas chronic liver disease showed the strongest negative association (aRR 0.90, 95% CI 0.88-0.92). Higher vaccine uptake among the non-elderly risk group was associated with increasing age, being born in Sweden, higher education, higher income, and living in a household where other adults had been vaccinated. Similar trends were observed for the first, second, third, and fourth dose.
Conclusion:
These results call for measures to tackle sociodemographic disparities in vaccination programmes during and beyond the COVID-19 pandemic. This article is protected by copyright. All rights reserved.
