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Published on: August 7, 2017
Geographic proximity to immunization providers and vaccine series completion among children ages 0-24 months
Rain E Freeman1, Cindy S Leary1, Jonathan M Graham2
1Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States.
Insights
Long travel distances are not a primary barrier to childhood vaccination completion in Montana. Rural children were less likely to be fully vaccinated, suggesting other factors like clinic resources and vaccine hesitancy play a larger role.
Area of Science:
- Public Health
- Epidemiology
- Geographic Information Systems (GIS)
Background:
- Childhood vaccination coverage in the U.S. is lower in rural compared to urban areas.
- Spatial accessibility to immunization services is a suspected risk factor for undervaccination in rural children.
Purpose of the Study:
- To determine if geographic factors, specifically driving distance to immunization providers, are associated with the completion of recommended childhood vaccinations.
- To investigate the relationship between residential proximity to vaccination services and timely immunization in a rural state.
Main Methods:
- Analysis of immunization records for children born between 2015-2017 in Montana.
- Calculation of road miles from residences to the nearest immunization provider using geolocated address data.
- Application of a multivariable log-linked binomial mixed model to identify factors associated with completing the 7-vaccine series by 24 months of age.
Main Results:
- Out of 26,085 children, 63.3% completed the 7-vaccine series by 24 months.
- Most children (92.1%) lived within 10 miles of a provider; long distances (>10 miles) showed a modest association with incomplete vaccination (aPR: 0.97).
- Children in rural areas were significantly less likely to complete the vaccination series compared to those in metropolitan areas (aPR: 0.88).
Conclusions:
- Long travel distances are not a significant barrier to childhood vaccination completion in Montana.
- Factors such as limited clinic resources and parental vaccine hesitancy may exert a greater influence on vaccination rates in rural populations.
- Further research should explore non-geographic barriers to timely childhood immunizations in underserved areas.
Objectives:
In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations.
Methods:
We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months.
Results:
Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92).
Conclusions:
Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.
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