Family Living Conditions, Parental Employment Conditions, and Health Care Delivery Experiences: Are These Factors Associated with Childhood Vaccination Coverage?

Background: In 2008, the National Immunization Survey (NIS) collected additional socioeconomic status (SES) information from parents of children aged 19 to 35 months for the first time in the history of the survey. This initiative was motivated by the desire to eliminate persistent racial/ethnic and poverty disparities in childhood vaccination. Unmeasured SES factors were believed to confound current efforts to eliminate these disparities.

Objectives: Evaluate whether SES factors such as current living conditions, parental employment conditions, and health care delivery experiences are associated with variations in childhood vaccination coverage.

Methods: Weighted data from the NIS supplemental SES module collected in January through June 2008 was used for the analysis. SES data were collected for 8,768 children; 7,665 had adequate vaccination provider data. The new SES measures addressed family living conditions, parental employment conditions, and health care delivery experiences. Vaccination coverage estimates were based on the 4:3:1:3:3:1 vaccine series (4+doses of DTaP vaccine, 3+doses of poliovirus vaccine, 1+doses of MMR vaccine, 3+doses of Hib, 3+doses of hepatitis B vaccine, and 1+doses of varicella vaccine).

Results: Significant coverage differences (p<0.05) were observed for almost all of the health care delivery variables compared to only some of the family living and parental employment condition variables. Higher vaccination coverage was observed for children whose guardian did not have to cancel an appointment for the child during the year (80.5% versus 70.9%), was able to get an appointment for the child when needed (78.7% versus 67.2%), had a wait time for the child to see the doctor of <15 minutes versus >30 minutes (79.4% versus 73.2%), had not refused/delayed a vaccine for the child (80.8% versus 64.1%), and had a regular doctor for the child (78.7% versus 57.9%) compared to other children.

Conclusions: Efforts to improve health care access and delivery are needed to further increase overall childhood vaccination coverage.