Assessment of Average Days Undervaccinated for U.S. Children Using the National Immunization Survey Open Access
Kalmus, Grace (Spring 2020)
Background: In the United States, childhood vaccination coverage is relatively high. However, increasing vaccine hesitancy and continued issues of access have led to increased delays in vaccination. While numerous metrics have been used to assess vaccination coverage, average days undervaccinated (ADU), a measure that accounts for every day of life a child is delayed, has not been assessed on a national level.
Methods: Weighted data from the 2017 National Immunization Survey – Child were used to assess vaccination delay among U.S. children ages 19 – 35 months. Vaccination delay was measured using the ADU metric, created by accounting for the time between when a child should have been vaccinated and when the child actually received the vaccination for every recommended dose. Linear and Poisson regression were used to assess the relationship between ADU, the number of vaccination providers a child saw, and other covariates of interest.
Results: In total, 68.2% of the children in the study population were undervaccinated for at least one day of life. Of these children with at least one day undervaccinated, the mean ADU was 94.3 days. ADU was higher for children with three or more vaccination providers than those with two, and was lowest for children with only one provider. Children who lived below the poverty level, were not the firstborn child, had a mother who was less than 30, and did not have private insurance were associated with an increased prevalence of having vaccine delay.
Conclusion: ADU is a measure of vaccine coverage that is more sensitive to vaccine delay than other measures commonly used. Factors associated with higher ADU can provide areas for public health intervention to decrease vaccine delay nationwide.
Table of Contents
Literature Review 1
Vaccination Trends in the United States 1
Consequences of Not Vaccinating 2
Characteristics of Under- and Unvaccinated Children 5
Reasons for Vaccine Refusal and Alternate Schedules 6
Measures of Vaccination Status 7
Thesis Rationale 10
Study Population 13
Study Variables 14
Average Days Undervaccinated 14
Predictor Variables 18
Data Analysis 18
Characteristics of Those With and Without Vaccine Delay 20
Mean ADU 20
Poisson Regression 21
Linear Regression 22
Estimates of Vaccine Delay 23
Number of Providers and Vaccination Status 26
Additional Factors 28
Strengths and Limitations 31
Public Health Implications 33
About this Master's Thesis
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