Study Design: A retrospective cohort analysis of vaccination delay using a cross-sectional sample consisting of 9,223 children 25-72 months of age from the 1992 - 1996 National Health Interview Survey (NHIS). The vaccination schedule recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices for DTP4, polio3, and MMR1 vaccine doses was used to determine if each dose was received age-appropriately.
Principal Findings: Black race, absence of a two-parent household, large family size, high school education level or less, and no insurance coverage were significantly related to an increased likelihood of delay for each the DTP4, polio3, and MMR1 doses (p <=.05). Male gender, non-Hispanic ethnicity, urban residence, suburban residence, poverty level, Medicaid enrollment, and absence of a usual provider were also significantly related to increased likelihood of vaccination delay for one or more of these vaccine doses (p <=.05). Risk models based upon up-to-date status did not reveal many of the risk factors that were observed in the models of vaccination delay.
Implications for Policy, Delivery or Practice: Understanding the risk of vaccination delay is important since many children experience lengthy delays before eventually receiving the vaccine doses that bring them up-to-date. Risk factor analyses indicate that families without insurance, children without a medical home, families with more that one child, and those from homes without a telephone have the greatest potential for reduction in vaccination delay. Consequently, provider and parent education programs that focus on the unique needs of those families may be beneficial.
See N/ALearning Objectives: Participants will be able to identify the risks of a child experiencing vaccination delay, and distinguish between these risks and those of not being up-to-date for vaccinations. In addition, participants will recognize the public health policy implications of this distinction.
Keywords: Immunizations, Risk Factors
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Research supported by a grant to Dr. Dombkowski from the Blue Cross / Blue Shield Foundation of Michigan