Introduction: Pregnant women are at an increased risk of hospitalizations from influenza. It has been reported that there is a difference in vaccination rates among pregnant women who are privately insured versus publicly insured. We compared vaccination rates for influenza and Tdap against nine different health insurance types to identify differences in vaccination rates among various health insurances. 

Methods: We used the Phase 8 (2016-2018) Pregnancy Risk Assessment Monitoring System (PRAMS) dataset which included 52,247 respondents with information on influenza and Tdap vaccination. We assessed: 1) fully vaccinated (flu + Tdap), 2) partially vaccinated (Flu or Tdap), 3) unvaccinated (no flu or Tdap). We categorized insurance status during pregnancy into nine levels including private, Health Care Exchange, Medicaid, SCHIP/CHIP, other government, military insurance, Indian Health Services (IHS), other insurance, or no insurance. 

Results: Pregnant women insured by Medicaid had 32% lower odds of being fully vaccinated (aOR 0.68, 95% Cl 0.58-0.80) compared to privately insured. Those insured via Health Care Exchange had 38% lower odds of being fully vaccinated (aOR 0.62, 95% Cl 0.49-78). Similarly, those with other government insurance (aOR 0.55, 95% Cl 0.38-0.78), other insurance (aOR 0.60, 95% Cl 0.44-0.81) and no insurance (aOR 0.30, 95% Cl 0.24-0.39) were less likely to be fully vaccinated when compared to private insurance. When looking at women who had a change in insurance status during their pregnancy, those who became uninsured (aOR 0.52, 95% Cl 0.36-0.63), became publicly insured (aOR 0.78, 95% Cl 0.65-0.93) and those who remained uninsured (aOR 0.28, 95% Cl 0.19-0.42) had lower odds of being fully vaccinated when compared to those who maintained the same health insurance during their pregnancy. 

Conclusion: We identified disparities in vaccination rates for influenza and Tdap during pregnancy based on health insurance type.