Do interventions that improve immunisation uptake also reduce social inequalities in uptake?

Area of Science:

• Public Health
• Epidemiology
• Social Medicine

Background:

• Childhood immunisation programs aim for high coverage.
• Social inequalities in healthcare access and uptake are a persistent public health concern.

Purpose of the Study:

• To evaluate if an intervention improving overall immunisation uptake influenced social inequalities in uptake among children.
• To analyze changes in immunisation uptake disparities between deprived and affluent areas post-intervention.

Main Methods:

• Cross-sectional small area analyses were conducted on four birth cohorts (1981-1991).
• Immunisation uptake (pertussis, diphtheria, measles) was measured in small areas classified by the Townsend deprivation score.
• Uptake differences and odds ratios between the most deprived and most affluent areas were calculated before and after the intervention.

Main Results:

• Overall immunisation coverage significantly increased across all vaccine types.
• Despite increased uptake, disparities between deprived and affluent areas persisted, with odds ratios indicating higher uptake in affluent areas.
• For pertussis, odds ratios increased from 1.2 to 2.3; for diphtheria, from 1.5 to 2.6; for measles, from 1.4 to 1.5, showing widening inequalities in some cases.

Conclusions:

• Interventions enhancing overall immunisation coverage did not reduce social inequalities in uptake.
• Health inequalities in immunisation persisted or worsened, particularly when uptake in affluent areas was below 95%.
• Targeted strategies may be necessary to address social disparities in childhood immunisation.