Vaccination coverage by race/ethnicity and poverty level among children aged 19-35 months - United States, 1996.
The NIS was implemented in 1994 and measures vaccination coverage among children aged 19-35 months (3). Race/ethnicity and poverty-related information are reported by the parent or caregiver through a random-digit-dialed telephone survey conducted in English, Spanish, and other languages. The health-care providers of the children in the survey are contacted to verify and/or complete vaccination information. An adjustment is made for households without telephones. Poverty level (i.e., above, at, or below the poverty level) is based on U.S. Bureau of the Census thresholds (4) for respondent-reported family income, household size, and number of children aged [is less than] 18 years living in the household. In 1996, interviews were completed with the parents and caregivers of 33,305 children aged 19-35 months (median age: 27 months). Of these children, 20,839 (63%) were non-Hispanic white; 5891 (18%), non-Hispanic black; 4852 (15%), Hispanic; 1172 (4%), Asian/Pacific Islander; 462 (1%), American Indian/Alaskan Native; and 89 ([is less than] 1%), other races.
Coverage by Race/Ethnicity
Most of the CII vaccination coverage goals for 1996 were met for individual vaccines for children in each of the five racial/ethnic groups (Table 1). The goals of 90% coverage with three or more doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP) and of 70% coverage with three or more doses of hepatitis B vaccine were met or exceeded for all five groups. The goal of 90% coverage with three or more doses of poliovirus vaccine was met or exceeded in all groups except Hispanics (89%; 95% confidence interval [Cl] = [+ or -] 1.2%) and American Indians/Alaskan Natives (89%; 95% Cl = [+ or -] 3.8%). The goal of 90% coverage with three or more doses of Haemophilus influenzae type b vaccine (Hib) was met or exceeded for all groups except Hispanics (89%; 95% Cl = [+ or -] 1.2%). The goal of 90% coverage with one or more doses of measles-containing vaccine (MCV) was exceeded for non-Hispanic whites and Asians/Pacific Islanders; coverage levels for non-Hispanic blacks, Hispanics, and American Indians/Alaskan Natives were [is less than] 90% but were within three percentage points of the goal. Coverage levels for all the individual vaccines except hepatitis B vaccine and for both the 4:31 and 4:31:3 series([sections]) were significantly lower among non-Hispanic blacks and Hispanics than among non-Hispanic whites (Table 1).
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Coverage by Poverty Level
Of the five 1996 CII coverage goals, three were not met for children living below the poverty level (levels for poliovirus vaccine, Hib, and MCV were 2, 2, and 3 percentage points below their corresponding goals, respectively) (Table 2). In comparison, all 1996 CII coverage goals were met or exceeded for children living at or above the poverty level.
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In 1996, coverage levels for all vaccines and series of vaccines were lower among children living below the poverty level than among children living at or above the poverty level (Table 2). For children living below the poverty level, levels ranged from 4 to 11 percentage points lower for individual vaccines than for children at or above the poverty level. For children living below the poverty level, the coverage levels for the 4:31 and 4:3:1:3 series were 10 and 11 percentage points lower, respectively.
Coverage by Race/Ethnicity and Poverty Level
Among children living below the poverty level, only the goal for hepatitis B was met in all five racial/ethnic groups. The DTP goal was met for all groups except Asians/Pacific Islanders. In general, the goals for poliovirus, Hib, and MCV were not met; however, the poliovirus and Hib goals were met for American Indians/Alaskan Natives, and the MCV goal was met for Asians/Pacific Islanders. In comparison, all goals were met or exceeded for children living at or above the poverty level, except for MCV for Hispanics and poliovirus vaccine and MCV for American Indians/Alaskan Natives.
For individual vaccines and by racial/ethnic group, the vaccination coverage levels of children living below the poverty level ranged from 2 percentage points higher to 13 percentage points lower than for children living at or above the poverty level. Similarly, for both the 4:31 and 4:31:3 series in individual racial/ethnic groups, the proportion of children who were series-complete was from 1 percentage point higher to 13 percentage points lower for children living below the poverty level (Table 2).
Editorial Note: The NIS is the first national vaccination survey measuring vaccination coverage for five racial/ethnic groups. Data from the NIS presented in this report indicate that the 1996 national CII vaccination coverage goals were met or exceeded for most or all of the targeted vaccines for each of five racial/ethnic groups. However, for children living below the poverty level, vaccination coverage was substantially lower than for those living at or above the poverty level and, in most racial/ethnic groups, three of the five CII goals were not met.
In general, the differences in vaccination coverage with individual vaccines among racial/ethnic groups found in the 1996 NIS (range: 0-6%) are smaller than those reported in earlier surveys. From 1970 to 1985, in the United States Immunization Survey of children aged 1-4 years, differences in individual vaccine coverage between white children and children of other races ranged from seven to 26 percentage points for three or more doses of DTP and poliovirus vaccine and for one or more doses of MCV (5). During 1992-1994, the National Health Interview Survey reported coverage differences between black and white children (aged 19-35 months) of three to 12 percentage points (6). Despite methodologic differences that limit comparisons of findings from the three surveys, it is unlikely that these methodologic differences alone account for the narrowing of the gap in coverage between non-Hispanic white children and children of the other racial/ethnic groups found in the data.
The narrowing of the small differences in coverage for the individual vaccines among the racial/ethnic groups may reflect nationwide efforts to increase vaccination levels, including activities following the resurgence of measles during 1988-1991 and those prompted by the CII since 1993 (1). State and local health departments and community and professional organizations have implemented multifaceted efforts in some major urban areas to improve vaccination levels among racial/ethnic minority populations. Strategies that avoid missed opportunities must be sustained and expanded (e.g., assessment of vaccination at service sites of the Special Supplemental Food Program for Women, Infants, and Children [WIC] , measuring and ranking vaccination coverage levels with feedback and incentives for providers , and reminder and recall). In particular, the WIC program serves approximately 44% of each annual birth cohort in the United States and is the single largest means of making contact with low-income preschool-aged children. Therefore, efforts to expand and strengthen the WIC/immunization linkage should be among the highest priority activities in improving coverage for children living below the poverty level.
The 1996 NIS findings suggest that socioeconomic differences account for a substantial proportion of the racial/ethnic group-specific differences in vaccination coverage. This conclusion is based especially on the similarities in vaccination coverage among children of different racial/ethnic groups living below the poverty level. However, the proportion of children aged [is less than] 5 years living below the poverty level (with corresponding lower levels of coverage) varies widely by race (i.e., 13.8% for whites, 17.5% for Asians/Pacific Islanders, 33.4% for Hispanics, 44.0% for blacks, and 44.4% for American Indians/Eskimos/Aleutians) (9). Some race-specific differences in coverage persisted despite adjusting for poverty: for children living above the poverty level, some vaccine-specific coverage levels differed by racial/ethnic groups, and within the groups, the apparent effect of poverty varied. The NIS findings described in this report indicate substantial progress toward achieving most of the 1996 CII goals for racial/ethnic groups. Despite this progress, efforts to increase vaccination coverage must be intensified to achieve coverage goals for all children, particularly children of racial/ethnic minority groups living in poverty. In particular, achievement of the year 2000 national health objective of 90% coverage of all U.S. children with the vaccines in the basic vaccination series (10) will require a fully functional vaccine-delivery system and sustained participation of communities, health-care providers, government officials, and private-sector partners (2). The elimination of vaccine-preventable diseases in the United States requires the achievement and maintenance of uniformly high vaccination coverage levels for preschool children in all communities. CDC will continue using the NIS to monitor progress toward meeting national health objectives for the year 2000 by race/ethnicity and by other factors associated with undervaccination.
(*) At least 90% coverage for one or more doses of measles-mumps-rubella vaccine and three doses each of diphtheria and tetanus toxoids and pertussis vaccine, oral poliovirus vaccine, and Haemophilus influenzae type b vaccine. For three or more doses of hepatitis B vaccine, the goals were set at 70% by 1996 and 90% by 1998. Children in this survey were born during February 1993-May 1995.
([dagger]) Five groups were used: respondents were self-classified as non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic American Indian/Alaskan Native, and non-Hispanic Asian/Pacific Islander.
([sections]) The 4:31 series is four or more doses of diphtheria and tetanus toxoids and pertussis vaccine/ diphtheria and tetanus toxoids, three or more doses of poliovirus vaccine, and one or more doses of MCV. The 4:3:1:3 series is the 4:31 series plus three or more doses of Hib.
(1.) CDC. Reported vaccine-preventable diseases--United States, 1993, and the Childhood Immunization Initiative. MMWR 1994;43:57-60.
(2.) CDC. Status report on the Childhood Immunization Initiative: national, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1996. MMWR 1997;46:657-64.
(3.) CDC. Sample design and procedures to produce estimates of vaccination coverage in the National Immunization Survey. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Immunization Program, 1996.
(4.) Bureau of the Census. Poverty in the United States, 1996. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1997. (Current population reports; series P60-198).
(5.) National Center for Health Statistics. Health, United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989:80; DHHS publication no. (PHS)89-1232.
(6.) National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1996:163; DHHS publication no. (PHS)96-1232.
(7.) Birkhead GS, LeBaron CW, Parsons P, et al. The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC): the impact of different strategies. JAMA 1995;274:312-6.
(8.) LeBaron CW, Chaney M, Baughman AL, at al. Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994. JAMA 1997;277:631-5.
(9.) Bureau of the Census. Social and economic characteristics, 1990. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1993; publication no. CP-2-1.
Reported by: National Center for Health Statistics; Assessment Br, Data Management Div, National Immunization Program, CDC.
(10.) Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991:122; DHHS publication no. (PHS)91-50212.
As part of its continuing commemoration of CDC's 50th anniversary in July 1996, MMWR is reprinting selected MMWR articles of historical interest to public health, accompanied by current editorial notes. Reprinted below is the report published June 29, 1974, that documented an association between the use of the Dalkon Shield intrauterine device and increased incidence of complicated pregnancies in women.
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|Publication:||Morbidity and Mortality Weekly Report|
|Date:||Oct 17, 1997|
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