Differences in influenza vaccination by gender identity and state-level gender equity policies: Behavioral Risk Factor Surveillance System, 2015-2019

Sarah N Cox; Mark A Fajans; Collrane J Frivold; Alyson J Littman; Jennifer E Balkus

doi:10.1016/j.ypmed.2023.107485

Differences in influenza vaccination by gender identity and state-level gender equity policies: Behavioral Risk Factor Surveillance System, 2015-2019

Prev Med. 2023 Jun:171:107485. doi: 10.1016/j.ypmed.2023.107485. Epub 2023 Mar 31.

Authors

Sarah N Cox¹, Mark A Fajans², Collrane J Frivold³, Alyson J Littman⁴, Jennifer E Balkus⁵

Affiliations

¹ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: sarahcox@uw.edu.
² Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: mfajans@uw.edu.
³ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: cfrivold@uw.edu.
⁴ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. Electronic address: alyson@uw.edu.
⁵ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: jbalkus@uw.edu.

PMID: 37003590
DOI: 10.1016/j.ypmed.2023.107485

Abstract

Background: It is estimated that there are one million transgender and over 340,000 gender non-conforming people in the United States, many of whom face significant health disparities including access to healthcare. Although previous studies have reported greater vaccine uptake in women compared to men, national-level estimates of influenza vaccine uptake among transgender and non-binary people are unknown. This study aims to characterize differences in influenza vaccine uptake by gender identity and examine associations between vaccination status and state-level gender equity policies.

Methods: We used cross-sectional data from adults participating in the 2015-2019 United States Behavioral Risk Factors Surveillance System surveys. Weighted prevalence differences (PDs) and associated confidence intervals (CIs) of being unvaccinated against influenza by self-reported gender identity were estimated using generalized linear regression models.

Results: Compared to cisgender women (unvaccinated prevalence = 57.3%), the prevalence of being unvaccinated was significantly higher among cisgender men (64.4%; PD = 7.0 per 100, 95% CI: 6.7-7.4), transgender women (65.4%; PD = 8.1 per 100, 95% CI 4.0-12.2), transgender men (64.6%; PD = 7.3 per 100, 95% CI: 2.7-11.8), and gender non-conforming individuals (64.6%; PD = 7.2 per 100, 95% CI: 1.3-13.2). This pattern was similar among individuals living in states with protective versus restrictive gender equity policies.

Conclusions: Our results identified a disparity in influenza vaccine uptake among individuals across the gender spectrum. To improve vaccine equity, future research should explore barriers to and facilitators of vaccine uptake by gender identity, which could inform policies and health promotion interventions to improve uptake co-designed and implemented with the transgender and non-binary communities.

Keywords: Gender; Health equity; Health policy; Immunization; Influenza; Non-binary; Transgender; Vaccination; Vaccine uptake.

MeSH terms

Adult
Behavioral Risk Factor Surveillance System
Cross-Sectional Studies
Female
Gender Equity
Gender Identity
Humans
Influenza Vaccines*
Influenza, Human* / prevention & control
Male
Policy
Transgender Persons*
United States
Vaccination

Substances

Influenza Vaccines