Effect of Race/Ethnicity, Poverty, and its Interaction on Missed Influenza Vaccine Receipt in 6-23 month U.S. Children Public

Abstract

Background: Children aged 6-23 months old are at high risk of influenza-associated hospitalization and death. In 2009, influenza vaccine recommendations were updated to include two doses of influenza, separated by four weeks, the first time a child, aged 6 to 23 months, is vaccinated. Racial and ethnic disparities have been documented for influenza vaccination in this population, but little is known about the combined impact of race/ethnicity and poverty-level disparities in influenza vaccine coverage in this age group.

Methods: Using provider-verified immunization history data from the 2013 National Immunization Survey, we assessed the independent effects of race/ethnicity and poverty status on influenza vaccine coverage among 6-23 month old children, as well as interaction of these factors. We conducted bivariate comparisons and evaluated the interaction of race/ethnicity and poverty status through multivariate logistic regression models.

Results: During the 2012-2013 influenza season, 60.8% of children aged 6 to 23 months were eligible for influenza vaccination. Of these eligible children, 61% did not get the influenza vaccine. In bivariate analysis, above poverty children were less likely to have not received influenza vaccine (odds ratio: 0.72, 95% confidence interval [CI]: 0.59, 0.88) compared to below poverty children. Compared to non-Hispanic white children, Non-Hispanic Black children had higher odds of missed vaccine receipt (odds ratio [OR]: 1.70, CI: 1.32, 2.19). In multivariate analysis, the only race/ethnicity and poverty level group with a significantly increased odds of lack of influenza vaccine was Non-Hispanic Black children living above poverty compared to non-Hispanic white children living above poverty (OR: 1.62, 95% CI: 1.10, 2.38).

Conclusions: The findings on the interaction of race/ethnicity and poverty status highlight the need to address both of these factors in tandem, to better identify the role of programs such as Vaccines for Children (VFC) in improving vaccine uptake in a way that transcends racial lines.

KEYWORDS: Seasonal influenza vaccine; vaccine coverage disparities; race/ethnicity and poverty interaction; 6-23 month old children; NIS

Table of Contents

Background/Literature Review 1-10

Abstract 11

Introduction 12

Methods 13-15

Results 15-17

Discussion 17-19

References 20-23

Tables 24-29

Conclusion 30-31

Appendix 32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, General
Mot-clé	seasonal influenza vaccine NIS vaccine coverage disparities
Committee Chair / Thesis Advisor	Bednarczyk, Robert A, Emory University

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