Comparison of rubella immunization rates in immigrant and Italian women of childbearing age: Results from the Italian behavioral surveillance system PASSI (2011-2015)

BACKGROUND International migration rapidly increased in the last decade, raising a renewed attention to its impact on public health. We evaluated differences in rubella immunization rate (RIR) between immigrant and Italian women of childbearing age and tried to identify the driving factors causing them. METHODS We analyzed data from the Italian behavioral surveillance system PASSI collected in 2011-2015 in a nationally representative sample of residents in Italy. The analysis was performed using log-binomial models to compare RIR between 41,094 Italian women and 3140 regular immigrant women of childbearing age (18-49 years), stratifying the latter by area of origin and length-of-stay in Italy (recent: ≤ 5-years; mid-term: 6-10-years; long-term: > 10-years). RESULTS Immigrant women showed a RIR of 36.0% compared to 60.2% among Italian women (RIR-ratio = 0.60, 95% confidence interval (CI): 0.57-0.63). Adjusting for demographic characteristics (i.e., sex, age and area of residence), socio-economic factors (i.e., education, occupation, family composition and economic status) and an indicator of the presence of at least one health-risk behavior (i.e., physical inactivity, current cigarette smoking, excessive alcohol consumption and excess weight) did not significantly change this difference (RIR-ratio = 0.56, 95% CI: 0.53-0.59). Recent immigrants (RIR-ratio = 0.47, 95% CI: 0.42-0.53) and immigrants from high migratory pressure countries (HMPC) in sub-Saharan Africa (RIR-ratio = 0.41, 95% CI: 0.31-0.56) and Asia (RIR-ratio = 0.42, 95% CI: 0.33-0.53) showed the greatest differences in RIR compared with Italian women. CONCLUSIONS Differences in RIR between immigrant and Italian women were not explained by different demographic, socioeconomic and health-risk behaviors characteristics. As entitlement to free-of-charge immunization in Italy is universal, regardless of migration status, other informal barriers (e.g., cultural and barriers to information access) might explain lower RIRs in immigrant women, especially recent immigrants and those from HMPC in sub-Saharan Africa and Asia. Further investigations are needed to identify obstacles and appropriate promotion and access-enabling strategies for rubella immunization.