Urban–rural and comorbidity-related differences in vaccination attitudes and self-reported adverse events following immunisation in Poland: a cross-sectional primary care study

Abstract

Background Vaccination attitudes and uptake are shaped by sociodemographic context, geography, and health status. How comorbidities and prior infection experiences interact with place of residence to influence vaccine decision-making remains insufficiently characterized in Polish primary care settings. Objective To compare vaccination attitudes, self-reported adverse events following immunisation (AEFI), and determinants of vaccination across large-city, small-city, and rural primary care populations in Poland, with particular attention to comorbidities and prior infectious disease experiences. Methods We conducted a cross-sectional study using questionnaire data linked to primary care records in three primary healthcare centres representing a large city, a small-to-medium city, and a rural setting. Group differences were assessed with contingency tables and Pearson’s chi-square tests (two-sided alpha 0.05). Multivariable logistic regression modeled uptake of influenza, COVID-19, and pertussis vaccination using comorbid respiratory, circulatory, and metabolic conditions and prior infection history as predictors. Results Vaccination coverage differed markedly by setting (p < 0.001), reaching 100% in the rural centre compared with 73–76% in urban centres. Self-reported AEFIs were least frequent among rural participants (7.1%) and most frequent among large-city participants (20.0%) (p < 0.001). Perceived information availability and quality, as well as trust in the healthcare system, varied across sites (all p < 0.001). In adjusted models, prior infection history and respiratory comorbidity were associated with higher odds of influenza vaccination (OR = 11.0; p < 0.001 and OR=3.9; p = 0.001, respectively) and COVID-19 vaccination (OR = 3.6; p < 0.001 and OR = 2.8; p = 0.010). Circulatory and metabolic conditions were not associated with influenza or COVID-19 vaccination (p > 0.05) but were inversely associated with pertussis vaccination in this sample (both p < 0.01). Conclusion Vaccination attitudes, uptake, and self-reported AEFIs differ substantially between urban and rural primary care settings in Poland. Respiratory comorbidity and prior infection experiences consistently predict vaccine uptake, underscoring the need for geographically tailored communication strategies and risk framing that reflects local context and chronic disease burden.