Race/ethnicity and gender disparities in the utilization of a school-based hepatitis B immunization initiative

To determine if participation and completion rates in a school-based hepatitis B vaccination program differ based on individual demographic factors including insurance status, race, and gender.

From 1998 through 2001, a school-based adolescent hepatitis B immunization initiative targeted elementary schools with a high percentage of free lunch and "at risk" students and provided free hepatitis B immunization (0,1, and 4 month schedule) during school hours. Demographic data were collected regarding potential enrollees in the project. The rate of return of consent/refusal forms, participation rates, and immunization completion rates were determined. Analyses were completed using the z statistic, frequencies, and stratified Chi-square analyses.

Families of female children (p <.0001) and those with insurance or Medicaid were more likely than those with no insurance (p <.0001) to respond by returning a consent or refusal form and were also more likely to participate in the program by receiving at least one immunization dose (p <.0001 for both analyses). Participation rates also varied by race (p <.0001) with black and Hispanic potential enrollees participating more frequently than white and Asian potential enrollees. Females among black (p =.012) and Hispanic (p <.0001) participants and participants of Asian race/ethnicity (p <.0001) were more likely to complete the vaccination series.

Even when access issues are eliminated as a potential barrier to hepatitis B immunization, gender and race disparities exist in the participation in, and completion of, the hepatitis B immunization series given in the schools. Race and gender clearly play separate and distinct roles in health care utilization, unrelated to the traditional variables of socioeconomic status often associated with access to care.