1. Karen Wooten, MA Elizabeth Luman, MS Lawrence Barker, PhD
Assessing Childhood Vaccination Coverage in The U.S. by Socioeconomic Status, : Does Income Affect Outcome?
Karen Wooten, MA
Elizabeth Luman, MS
Lawrence Barker, PhD

2. Background Childhood vaccination coverage is at an all-time high
Socioeconomic Status (SES)– one of the most powerful predictors of Health
For Good Health, studies report it helps to be Rich
Persistent Low vaccination coverage among children are associated with living in poverty defined households (Klevens, M; Luman, E)

3. Research Questions
What effect does Socioeconomic status have on childhood vaccination coverage rates?
Which is a better predictor of Vaccination Coverage in Children: Mother’s Education or Socioeconomic Status?
When socioeconomic status and mother’s education factors are accounted for, do racial disparities in vaccination coverage persist?

4. Methods: Data Used National Immunization Survey (NIS), 1999-2002
Children between 19 and 35 months of age
Random Digit Dialed (RDD) Telephone Survey
Parents reported vaccination history via telephone
Providers reported vaccination history via Mail
Weighted for national representation of children months of age

5. Methods: Outcome Measure
Vaccination Coverage is based on up-to-date status of the 4:3:1:3 Series:
4+ doses of Diphtheria and Tetanus toxoids and pertussis vaccine
3+ doses of any poliovirus vaccine
1+ doses of measles-containing vaccine
3+ doses of Haemophilus Influenzae type B vaccine
Only children with provider-reported vaccination histories were included in the analysis

6. Methods: SES Measures Mother’s Education: H.S. or lower vs. > H.S.
Socioeconomic Status (SES)- 6 levels:
Severe poverty (ratio < 50%)
Intermediate poverty (ratio 50 to < 100%)
Near poverty (ratio 100 to <125%)
Low middle SES (ratio > %)
Middle SES (ratio > %)
Upper SES (> 600%) above poverty

7. Methods: Other Explanatory Measures
Geographic:
Region (Northeast, Midwest, South, West)
Population Density (Urban, Suburban, Rural)
Demographic:
Race/Ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanics, Other)
Marital Status (currently married vs. not married) .

8. Methods: Analysis Strategy
Analysis conducted using SUDAAN Software Package
Survey analysis tool for complex sample survey data
Chi Square Test for Trends
Bivariate and Multivariate Logistic Regression:
Wald Chi Square Tests of Significance
Odds Ratios (Crude and Adjusted)

9. Results

10. Vaccination Coverage (4:3:1:3 Series) by Socioeconomic Status

11. Childhood Vaccination, 1999-2002: Up to date for 4:3:1:3 Series by Mother’s Education

12. Likelihood of Vaccination (Adjusted Odds Ratios) by Socioeconomic Status and Mother’s Education
Status Levels:
1999
2000
2001
2002
Severe (<50% poverty)
.71*
.82
.86
.91
Below (50-100%)
.81*
.97
.94
1.01
At (100%-125%)
.81
1.13
.88
Low (125%-300%)
Reference
Middle (300%-600%)
1.15
1.37*
1.38*
1.43*
Upper (>600%)
1.24
1.86*
1.83*
Education: < H.S.
> H.S.
1.30*
1.26*
1.29*

13. Influence of Socioeconomic Status and Mothers’ Education on Race/Ethnicity
Household SES
1999
2000
2001
2002
White, Non-Hispanic √
Black, Non-Hispanic
Hispanic
Mother’s Education
Adjusted by Demographic and Geographic Factors

14. Influence of Socioeconomic Status and Mother’s Education on
Influence of Socioeconomic Status and Mother’s Education on *Race/Ethnicity
Base Model
1999
2000
2001
2002
Whites
1.24
1.33
1.51
Hispanics
1.03
1.34
1.27
Other
1.07
1.05
1.28
1.42
*Black children represent the reference group

15. Influence of Socioeconomic Status and Mothers’ Education on
Influence of Socioeconomic Status and Mothers’ Education on *Race/Ethnicity
Base Model
1999
2000
2001
2002
Whites
1.24
1.33
1.51
Hispanics
1.03
1.34
1.27
Other
1.07
1.05
1.28
1.42
Base Plus Socioeconomic Status Model:
1.09
1.19
1.40
1.11
1.30
1.43
0.94
1.20
1.38
*Black children represent the reference group

16. Influence of Socioeconomic Status and Mothers’ Education on
Influence of Socioeconomic Status and Mothers’ Education on *Race/Ethnicity
Base Model
1999
2000
2001
2002
Whites
1.24
1.33
1.51
Hispanics
1.03
1.34
1.27
Other
1.07
1.05
1.28
1.42
1999
2000
2001
2002
Base Model: Plus Mother’s Education
Whites
1.24
1.30
1.29
1.47
Hispanics
1.12
1.11
1.44
1.37
Other
1.03
1.05
1.26
1.39
*Black children represent the reference group

17. Influence of Socioeconomic Status and Mothers’ Education on
Influence of Socioeconomic Status and Mothers’ Education on *Race/Ethnicity
Base Model
1999
2000
2001
2002
Whites
1.24
1.33
1.51
Hispanics
1.03
1.34
1.27
Other
1.07
1.05
1.28
1.42
Base Model: Plus SES and Education
1999
2000
2001
2002
Whites
1.09
1.21
1.19
1.42
Hispanics
1.16
1.07
1.33
1.48
Other
0.93
1.05
1.20
1.38
*Black children represent the reference group

18. Influence of Socioeconomic Status and Mothers’ Education on
Influence of Socioeconomic Status and Mothers’ Education on *Race/Ethnicity
Base Model
1999
2000
2001
2002
Whites
1.24
1.33
1.51
Hispanics
1.03
1.34
1.27
Other
1.07
1.05
1.28
1.42
Base Model: Plus Socioeconomic Status
1.09
1.19
1.40
1.11
1.30
1.43
0.94
1.20
1.38
1999
2000
2001
2002
Base Model: Plus Socioeconomic Status and Mother’s Education
Whites
1.09
1.21
1.19
1.42
Hispanics
1.16
1.07
1.33
1.48
Other
0.93
1.05
1.20
1.38
*Black children represent the reference group

19. Summary of Findings
Children living in upper SES households are vaccinated more often than children living in lower SES households
Of the two factors -Socioeconomic Status (SES) and Mother’s Education, SES is the strongest independent predictor of vaccination coverage
Mother’s education is a strong predictor of vaccination coverage
Is not a significant factor in reducing racial disparities

20. Limitations
Some vaccination providers were not identified, did not respond to the NIS, or did not complete
Incomplete medical records may result in underreporting of up-to-date vaccination status
Age and interval appropriateness of vaccinations were not taken into account

21. Conclusions
Racial differences in vaccination coverage may be due to differences in socioeconomic status
Differences between black, non-Hispanic and White, Non-Hispanic may be due to an additive or multiplicative effect of socioeconomic status and mother’s education
Persistent disparities in coverage between Hispanic children and Non-Hispanic Black children may be due to the types of interventions that target the Hispanic population.