ATLANTA – Rotavirus vaccination is significantly decreased among children without health insurance and among those whose parents did not graduate from college, according to data from the National Immunization Survey 2009.
The 2,174 children in the survey who did not have health insurance were 12% more likely to not be vaccinated than the 14,761 children in the survey who had health insurance, and the 9,322 children with a parent who did not graduate from college were 21% more likely to not be vaccinated than the 7,731 with a parent who did graduate from college, Koya C. Allen reported in a poster at the International Conference on Emerging Infectious Diseases.
The survey data showed that the 2,174 children in the survey who did not have health insurance were 12% more likely to not be vaccinated than were the 14,761 children in the survey who had health insurance
The findings underscore the importance of developing educational strategies for improving access to health care among parents with lower income and lower educational attainment, said Ms. Allen, a PhD candidate at Kent (Ohio) State University.
The National Immunization Survey 2009 included more than 25,000 households. Of those, about 17,000 provided adequate data for this study, and those data indicated that rotavirus coverage among children aged 19-35 months between Jan. 6, 2009, and Feb. 10, 2010, was only 72%. Despite the unanticipated benefits of vaccination, including some herd immunity that reduced transmission and conferred protection to the unvaccinated population including older children not eligible for vaccination, it is necessary to ensure increased access to vaccine for age-appropriate children to reduce transmission rates even further, and to eliminate disparities in vaccine distribution, Ms. Allen noted.
In addition to insurance and education, the child’s age group, ethnicity, geographical region, and type of health care provider were found to be significantly associated with vaccination coverage. For example, children aged 24-29 months and 30-35 months were significantly more likely to not be vaccinated than those aged 19-23 months (odds ratios, 3.05 and 1.56, respectively), and non-Hispanic blacks, non-Hispanic whites, and multirace children all were significantly more likely to not be vaccinated than Hispanic children (OR, 1.21, 1.22, and 1.38, respectively). Those living in the South were significantly less likely to not be vaccinated than those in the Northeast (OR, 0.80), and those whose provider worked at a private facility were significantly less likely to not be vaccinated than those whose provider worked at a public facility (OR, 0.77).
The increased vaccination rate among Hispanics may be explained by geographic region or the way the categories for ethnicity were made for this study, Ms. Allen noted, adding, "The geographical region and age group associations both have plausible explanations to explain the increased probability for vaccination in the South and in younger children. The age restrictions on eligibility to receive the vaccine, in addition to introduction of the vaccine in 2006, make the highest likelihood for vaccination expected in the youngest age group. The increased probability of receiving the vaccine in the South during this time may be explained by an apparent increased incidence of rotavirus transmission in the South during the 2008-2009 seasons."
That outbreak in the South may have increased the probability of vaccination there, she explained.
This study also demonstrated interactions between the type of provider, income, and vaccination rates.
For example, individuals whose provider was at a hospital were 36% less likely to not have had insurance than those whose provider was a public facility, and individuals who had a private care provider were 52% less likely to not have insurance than those whose provider was a public facility.
"So, children whose health care provider is a public facility are more likely to have insurance and, therefore, more likely to receive the vaccination," she noted.
Also, insurance was associated with income level. Those from families making $75,000 or less per year were 4.6 times more likely not to have had insurance, compared with those making more than that, and those with an income below the poverty level were nearly 5.5 times more likely not to have had insurance than those with an income of more than $75,000 per year.
"Insurance proved to be a significant determinant of receiving vaccination, with income as a partial mediator when accounted for with other significant predictors. Further analysis should be conducted to see if this trend exists in the National Immunization Survey 2010," Ms. Allen wrote.
Further study should also look at the impact in the changing health insurance coverage for the United States on distribution of vaccine and alleviation of disparities in insurance type and access to vaccinations, she added.