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Personal, financial, and structural barriers to immunization in socioeconomically disadvantaged urban children
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Objective:
To evaluate personal, financial, and structural barriers to vaccination in socioeconomically disadvantaged urban children in the first 2 years of life.
Design:
Prospective cohort study.
Setting:
A large municipal teaching hospital in the Midwest.
Participants:
Healthy term newborns discharged to the care of their mothers. Mothers were interviewed 24 to 72 hours postpartum regarding personal and financial barriers, and 2 years later regarding personal, financial, and structural barriers to care.
Main Outcome Measure:
Vaccination status at age 2 years.
Results:
Of 399 children with documented vaccination status, 47% had not received all recommended vaccinations by 2 years of age. After adjusting for mother's age, race, and education, mothers who were unmarried (adjusted odds ratio [AOR] 1.74; 95% confidence interval [CI]: 1.05, 2.90), multiparous (AOR 2.10; 95% CI: 1.26, 3.52), not coresident with the child's grandmother (AOR 1.75; 95% CI: 1.01, 3.03), had not received adequate prenatal care (AOR 1.78; 95% CI: 1.12, 2.84), or lived in poverty (AOR 2.62; 95% CI: 1.44, 4.75) were more likely to have undervaccinated children, as were mothers who perceived less satisfaction with their child's health care (AOR 1.63; 95% CI: 1.01, 2.61), less control over their lives (AOR 2.01; 95% CI: 1.03, 3.94), or more benefit of medical care to prevent vaccine-related diseases (AOR 1.76; 95% CI: 1.25, 2.48).
Conclusions:
Family environment, a mother's history of prenatal care use, and financial barriers are important factors related to vaccination receipt among socioeconomically disadvantaged children at age 2 years. These factors, however, do not fully explain the variation in vaccination status.