Tuesday, March 18, 2008

Racial Disparities in Immunization Coverage Levels Among Children Aged 24 Months — Tennessee

Sapana Parikh, Office of Workforce and Career Development, Centers for Disease Control and Prevention, 425 5th Avenue North, Cordell Hull Building, 1st Floor, Nashville, TN, USA and Kelly L. Moore, Tennessee Immunization Program, Tennessee Department of Health, 425 5th Avenue North, Cordell Hull Building, 1st Floor, Nashville, TN, USA.

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to understand immunization disparities in Tennessee

Since 1980, the Tennessee Immunization Program has conducted annual surveys to estimate immunization status of Tennessee residents aged 24 months; no rigorous statistical analysis of racial differences was performed.

To analyze immunization coverage of black and white 24-month-olds born January–March 2005.

A survey sample (n = 1,585), drawn from birth certificates of residents born January–March 2005 was oversampled for blacks. Exclusion criteria included state relocation, refusal to participate, or death (n = 102). Non-white or non-black races (n = 32) were excluded from this analysis. Children not located were included (n = 29) as incompletely immunized. Immunization history was gathered from the Tennessee Immunization Registry. For children with incomplete immunization histories, parents/guardians and immunization providers were contacted for immunization dates.
The 4:3:1:3:3:1 immunization series is defined by the following immunization doses: 4 diphtheria and tetanus toxoids and acellular pertussis (DTaP) or tetanus and diphtheria (DT); 3 polio; 1 measles, mumps, rubella; 3 Haemophilus influenzae type B; 3 hepatitis B; and 1 varicella.

White children were more likely to complete the 4:3:1:3:3:1 series than black children by age 24 months (84.2% [1,005/1,194] versus 77.0% [198/257]; relative difference {RD}: 8.6; odds ratio {OR}: 1.6 [confidence interval {CI}, 1.1–2.2]; P = 0.006). DTaP has the widest disparity in immunization of all six vaccines. White children were more likely to have completed 4 doses of DTaP (87.9% [1,050/1,194] versus 80.9% [208/257]; RD: 8.0; OR: 1.7 [CI, 1.2–2.5]; P = 0.003). Seventeen of 1,194 (1.4%) white children and 12 of 257 (4.7%) black children were not located (categorized as incompletely immunized).

Differences in immunization rates between black and white children aged 24 months were detected in the 2007 survey. Tennessee will raise awareness of this disparity among immunization providers.