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Spatial accessibility to providers and vaccination compliance among children with medicaid
Linda Y Fu1, Nuala Cowan, Rosie McLaren
1Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA. lfu@cnmc.org
Insights
Children with better access to pediatric vaccination providers were more likely to be up-to-date on immunizations. This finding highlights the importance of accessible healthcare for ensuring vaccination compliance in urban areas.
Area of Science:
- Public Health
- Urban Health
- Health Services Research
Background:
- Vaccination compliance is crucial for child health.
- Spatial accessibility to healthcare may influence vaccination rates.
- Understanding these factors is vital for low-income, urban populations.
Purpose of the Study:
- To examine the link between spatial accessibility to pediatric immunization providers and vaccination compliance.
- To assess this relationship in a low-income, urban population.
Main Methods:
- Data from 4195 children (19-35 months, Medicaid) in Washington, DC, 2007.
- Spatial accessibility calculated using provider-to-population ratios.
- Logistic regression analyzed the association with vaccination compliance.
Main Results:
- 80.5% of children were up-to-date on vaccinations.
- Higher spatial accessibility was linked to increased odds of being up-to-date (36% higher odds for highest access).
- Medium access also showed increased odds (25% higher).
Conclusions:
- Increased spatial accessibility to pediatric vaccination providers is associated with higher vaccination compliance in urban, low-income children.
- Findings suggest that improving access can enhance immunization coverage.
- This may inform future public health strategies.
Objective:
We examined the relationship between spatial accessibility to pediatric immunization providers and vaccination compliance in a low-income, urban population of children.
Methods:
In 2007, we accessed the Washington, DC, Immunization Information System (IIS) to collect data on the immunization statuses and residential addresses of children who were aged 19 to 35 months and had Medicaid insurance. In addition, we calculated each child's spatial accessibility to pediatric vaccination providers by assessing the provider-to-population ratio at each residential address. Spatial accessibility was divided into tertiles (low, medium, and high) of access. The relationship between spatial accessibility to providers and vaccination compliance was examined by using logistic regression analysis adjusting for age, type of vaccination provider, and enrollment in child care status.
Results:
Overall for our cohort of 4195 children, 80.5% of the children were up-to-date with vaccinations. Vaccination coverage ranged from 61.6% to 100% (median: 79.2%) among different neighborhoods. Having the highest level of access to pediatric vaccination providers was associated with 36% higher odds of being up-to-date as compared with having the lowest level of access. The middle tertile of access was associated with 25% higher odds of being up-to-date.
Conclusions:
Within our low-income, urban population, children with higher spatial accessibility to pediatric vaccination providers were more likely to be up-to-date with vaccinations. This association may guide future studies and efforts to ensure adequate immunization coverage for children regardless of where they live.
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