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UKnowledge > College of Public Health > Journal of Appalachian Health > Vol. 8 (2026) > Iss. 1

 

Corresponding Author

Claudia P. Valenzuela; qat5@cdc.gov

Author Affiliations

  1. Claudia P. Valenzuela, MPH: Statistician, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention (Hyattsville MD); E-mail: qat5@cdc.gov; ORCiD: https://orcid.org/0000-0003-1122-204X
  2. Anne K. Driscoll, PhD: Statistician, Demographer, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention;ORCiD: https://orcid.org/0000-0002-8537-8816
  3. Elizabeth M. Harvey, PhD, MPH: Assistant Commissioner for Family Health and Wellness, Tennessee Department of Health (Nashville TN); ORCiD: https://orcid.org/0000-0002-2046-0472
  4. Heather E. Wingate, MPH: Viral Hepatitis Surveillance Director, Epidemiologist II, Tennessee Department of Health; ORCiD: https://orcid.org/0000- 0002-3244-2052

Author Area of Expertise

Valenzuela: Vital statistics

Driscoll: Demography

Harvey: Maternal and child public health administration and applied epidemiology.

Wingate: Infectious disease surveillance

Abstract

Introduction: Throughout the pandemic, COVID-19 vaccination coverage was lower for the general population living in rural counties than in urban counties. In Tennessee (TN), COVID-19 vaccinations became available to pregnant women in March 2021. Little is known about rates of COVID-19 vaccination in pregnancy during the pandemic, or whether these rates changed or differed by urbanization level.

Purpose: The purpose of this study is to describe COVID-19 vaccination rates among pregnant women in TN by month of conception and urbanization level.

Methods: COVID-19 vaccination data from the TN Immunization Information System and the TN Surveillance for Emerging Threats to Mothers and Babies Network for women who conceived between March – November 2021 were linked to birth data from the National Center for Health Statistics. Women were categorized based on the urbanization level of their county of residence.

Results: Vaccination rates during pregnancy were highest for women in large central metropolitan counties and lowest for women in rural counties. Among women who conceived in March 2021, those living in urban counties were 1.5 – 2 times as likely to be vaccinated as those living in rural counties. From March – November 2021, declines in vaccination rates were observed for all urbanization levels with larger declines in urban counties. There was no significant difference in vaccination rates across all urbanization levels among women who conceived in November 2021.

Implications: Differences noted in vaccination rates, particularly at the beginning of an outbreak, can help inform decision-makers on where and how to direct vaccination resources.

DOI

https://doi.org/10.13023/jah.0801.07

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Valenzuela CP, Driscoll AK, Harvey EM, Wingate HE. First Covid-19 vaccination rates among pregnant Tennessee women by month of conception and urbanization level: March 2021 – November 2021. J Appalach Health 2026; 8(1):85-95. DOI: https://doi.org/10.13023/jah.0801.07

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