Poverty, Race/Ethnicity, Insurance, and Tdap Coverage among 13-17 Year-Old Adolescents

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to describe the associations between poverty, race/ethnicity, insurance coverage, and Td containing vaccination coverage.

Background:
Having health insurance has been shown to be associated with higher vaccination coverage among infants.

Objectives:
To describe the associations between poverty, race/ethnicity, insurance coverage, and Td containing Td or Tdap vaccination coverage among 13-17 year olds.

Methods:
2,872 13-17 year-olds sampled by the National Immunization Teen Survey in 2006, stratified by family income (≤135% of the federal poverty level (FPL) - low income; ≥400% of the FPL - high-income). Adolescents who received 1+ doses of Td containing vaccine since age 10 years were considered to be up-to-date (UTD).

Results:
In 2006, 32.0% ±2.3% of all 13-17 year-olds lived in a low-income household. Hispanic, single race non-Hispanic black, non-Hispanic other single race, and multi-racial adolescents were significantly more likely to live in a low-income household compared to single race non-Hispanic whites (62.8%, 54.1%, 42.7%, 31.3% vs. 18.8%, p<0.05). Adolescents in a low-income household were significantly more likely to be uninsured compared to adolescents living in a high-income household (12.8% vs. 1.2%, p<0.05).
Adolescents living in low and high-income households were more likely to be UTD if they had health insurance (low-income: 57.1% ±4.9% vs. 46.7% ±14.0%, p=0.085; and high-income: 64.5% ±3.8% vs. 30.1% ±27.8%, p<0.01). Among adolescents with health insurance, those living in high-income households were significantly more likely to be UTD compared to adolescents living in low-income households (64.5% vs. 57.1%, p<0.01).

Conclusions:
Disparities in Td-containing vaccination coverage since 10 years among adolescents exist depending on family income. Although adolescents living in low-income may have higher coverage if they have health insurance, adolescents with health insurance in high-income households have significantly higher vaccination coverage than adolescents in low-income households with health insurance.