Association of parental education with adolescents' COVID-19 vaccine uptake: A nationwide register-based study in Finland

Evidence regarding the link between parental education and adolescents' COVID-19 vaccination status mostly originates from non-representative survey studies, and the results are mixed. Although some register-based studies have shown a positive association with higher parental education and adolescent COVID-19 vaccine uptake, the factors behind these differences remain largely unexplored. We used total population-level Finnish register data on 12-17-year-olds (N = 360,281) linked with their parents and household members. Logistic regression models were employed to analyse the association between parental education and the likelihood of receiving the first COVID-19 vaccine dose by the end of 2022. The Karlson-Holm-Breen (KHB) method was used to quantify the extent to which parental age, family structure, household income, migration background, previous COVID-19 infection, presence of risk group household members, and parental COVID-19 vaccination status confounded or mediated the association. Adolescents with at least one parent with upper tertiary education had higher COVID-19 vaccine uptake (92 %) than those whose parents had only basic education (58 %), with an odds ratio [OR] of 8.60 (95 % CI 8.20-9.02) in the baseline model. Together the adjustments confounded or mediated over 80 % of the association, with parental COVID-19 vaccine uptake and household income being the strongest explanatory factors. For example, adjusting for parental COVID-19 vaccination status attenuated the OR to 3.85 (95 % CI 3.61-4.12). In the fully adjusted model, the OR remained at 1.55 (95 % CI 1.45-1.67). The results were highly similar when using household income as the socioeconomic status measure. Parental education was a strong predictor of adolescents' COVID-19 vaccine uptake in Finland. Parental vaccination status emerged as an important mediator of the association, possibly indicating general vaccine hesitancy. Other factors behind the educational differences included household income, migration background, and parental age.