Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to describe vaccination coverage by provider type, race/ethnic group, area of residence, and income.

Background:
Although overall childhood immunization rates have been increasing, little is known about coverage differences by provider type and how these differences vary by child's race/ethnicity, area of residence, and income.

Objectives:
Describe changes in childhood immunization coverage rates by provider type between 1996 and 2004.

Methods:
Changes in immunization coverage rates among children 19-35 months were compared between 1996 and 2004, using 43133 series (4DTaP, 3IPV, 1MMR, 3Hib, and 3HepB) data in the National Immunization Survey. Differences in rates were examined by provider type (private, public or a mix of providers), and further stratified by child's race/ethnicity (black, Hispanic, white), area of residence (urban, suburban, rural), and income level (above or below poverty).

Results:
In 2004 all provider types showed significant increases in coverage compared to 1996; private providers had higher coverage rates than public and similar rates to mixed (83% vs 79% vs 83%, respectively). The proportion of children seeing private providers significantly increased from 58% to 62% during the study period (p<.01). For private providers, when children were stratified by race/ethnicity, residence, and income, all groups showed significant increases in coverage (p<.01), and white children maintained significantly higher coverage than blacks or Hispanics in both years (p< .01). In comparison, among black children seeing public or mixed providers, coverage rates did not significantly increase between 1996 and 2004; similar results were seen among children from urban or rural areas seeing mixed providers. Among all provider types children ‘below poverty' had significantly lower coverage.

Conclusions:
The persistent disparities found in immunization coverage by provider type suggest that greater emphasis needs to be placed on provider's efforts to increase up-to-date rates for children of all race/ethnic, income and residential groups.