Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: results from a national survey

Figures & data

Figure 1. Study flow chart, 2016 French National Perinatal Survey

Table 1. Influenza vaccine uptake and associated factors among women in mainland France, 2015–2016 season

	n	Rate (%)	p value^a	PR^b	95% CI	p value^c
TOTAL	11712	7.4
Age (years)			<0.001			<0.001
<25	1502	4.1		1
25-29	3719	6.3		1.17	0.87–1.57
30-34	4011	9.1		1.60	1.20–2.14
35 or more	2480	8.3		1.56	1.14–2.13
Parity			<0.001			<0.001
0	4972	8.3		2.11	1.39–3.20
1-2	5878	7.2		1.73	1.15–2.60
3 or more	862	3.0		1
Medical conditions			0.002			0.001
None	9693	7.4		1
Preexisting conditions at risk for flu	450	11.8		1.69	1.29–2.20
Other preexisting conditions^d	439	6.8		1.03	0.72–1.47
Hospitalization during pregnancy	1130	6.2		0.91	0.72–1.16
Family status			0.21			0.054
Cohabiting	10714	7.5		1
Not cohabiting	975	6.4		1.31	1.00–1.72
Educational level			<0.001			<0.001
Middle school or less	2660	4.4		1
High school	2511	4.5		0.92	0.71–1.20
Some college	2240	6.1		1.14	0.89–1.47
College	2115	9.3		1.61	1.27–2.04
Postgraduate	2087	14.3		2.54	2.01–3.20
Maternal country of birth			0.003			0.86
France	9543	7.7		1
Other countries	2168	5.9		1.02	0.83–1.24
Maternal occupation during pregnancy			<0.001			<0.001
Healthcare worker	1522	13.1		1.76	1.50–2.06
Contact with children	801	9.9		1.17	0.92–1.48
Other	5966	7.3		1
Not working during pregnancy	3406	4.4		0.89	0.73–1.10
Complementary health insurance^e			<0.001			0.39
Public insurance (CMU-C)	1061	4.5		1.25	0.81–1.92
Private insurance	9560	8.1		1.27	0.90–1.80
None	1009	3.8		1
Number of prenatal visits			0.12			0.45
Low	2217	6.2		0.88	0.70–1.10
Average	1921	7.8		1
High	4741	7.8		0.99	0.83–1.19
Very high	2681	7.6		1.04	0.85–1.27
Main healthcare provider			0.015			0.03
Ob-gyn (private)	5771	7.7		1
Ob-gyn (public)	1852	7.5		1.05	0.87–1.26
Midwife (private)	988	6.9		0.77	0.60–0.98
Midwife (public)	1720	5.9		0.90	0.74–1.11
General practitioner	758	9.9		1.29	1.01–1.66
Other^f	523	6.5		1.18	0.85–1.63

CI: confidence interval; CMU-C: universal complementary health coverage; Ob-gyn: obstetrician-gynecologist; PR: prevalence ratio.

The number of missing data varies for each characteristic; n = 11,264 in the final robust Poisson regression model.

^aPearson chi-square test.

^bPrevalence ratios adjusted for all variables in the table and administrative regions.

^cWald test.

^dMedical conditions requiring care by an obstetrician-gynecologist.

^eFor additional costs not covered by the national health insurance; public insurance is for low-income people.

^fMaternal and Child Health Services or several care providers.

Table 2. Distribution of prescribers by main care provider during the first six months of pregnancy^a.

		Vaccine prescriber (%)^b
Main care provider	N (%)^c	Ob-gyn	Midwife	GP	Other
Ob-gyn	574 (67.6)	49.5	4.7	25.6	20.2
Midwife	170 (20.0)	5.9	39.4	33.5	21.2
General practitioner	72 (8.5)	1.4	9.7	81.9	6.9
Other^d	33 (3.9)	21.2	24.2	24.2	30.3
Total	849 (100)^e	302 (35.6)	109 (12.8)	271 (32.0)	167 (19.7)

Ob-gyn: obstetrician-gynecologist.

^aPearson chi-square test (p < 0.001).

^bDistribution of the qualification of prescribers.

^cDistribution of the main care providers.

^dMaternal and Child Health Services or several care providers.

^eAmong 865 vaccinated women, the vaccine prescriber was unknown for 13 women and was the main care provider for 3 women.

Table 3. Vaccine refusal rates according to maternal characteristics in mainland France, 2015–2016 season

	n	Rate (%)	p value^a	PR^b	95% CI	p value^c
TOTAL	2921	70.4
Age (years)			0.007			0.11
<25	259	76.1		1.09	1.00–1.19
25-29	867	73.1		1.07	1.01–1.13
30-34	1118	67.4		1
35 or more	677	69.7		1.03	0.97–1.10
Parity			<0.001			<0.001
0	1260	67.1		1
1-2	1505	71.8		1.08	1.03–1.14
3 or more	156	83.3		1.22	1.11–1.34
Medical conditions			0.2			0.55
None	2383	70.1		1
Preexisting conditions at risk for flu	155	65.8		0.94	0.84–1.06
Other preexisting conditions^d	129	76.7		1.05	0.95–1.16
Hospitalization during pregnancy	254	72.4		1.01	0.93–1.10
Educational level			<0.001			<0.001
Middle school or less	487	76.0		1.31	1.20–1.43
High school	502	77.7		1.34	1.23–1.46
Some college	556	75.5		1.30	1.19–1.41
College	657	70.0		1.22	1.12–1.33
Postgraduate	699	57.2		1
Maternal occupation during pregnancy			0.019			0.28
Healthcare worker	679	70.7		1.00	0.94–1.06
Contact with children	211	62.6		0.90	0.81–1.01
Other	1457	69.9		1
Not working during pregnancy	573	74.0		0.97	0.91–1.04

CI: confidence interval; PR: prevalence ratio.

The number of missing data varies for each characteristic; n = 2,840 in the final robust Poisson regression model.

^aPearson chi-square test.

^bPrevalence ratios adjusted for all variables in the table and family status, maternal country of birth, complementary health insurance, number of prenatal visits and qualification of the main care provider.

^cWald test.

^dMedical conditions requiring care by an obstetrician-gynecologist.