The underserved suffer from undervaccination
Specific SDOH impact vaccination rates for children up to age 24 months.1,2
Before the pandemic, persistent disparities were observed in routine vaccination coverage by health insurance status, race and ethnicity, and poverty status.1 These gaps in recommended vaccinations remained steady or worsened during the COVID-19 pandemic.2-6
According to the National Immunization Survey-Child data collected in 2022, for children born during 2019-2020, coverage by 24 months with most childhood vaccines was lower among uninsured who were Black, Hispanic, and American Indian or Alaska Native.1,2,a
Estimated vaccination coverage in infants and children born during 2019-2020 who received the combined 7-vaccination series by age 24 months according to the National Immunization Survey-Child, 2020–20221,a:
Health Insurance Status1,b
Race/Ethnicity2
Poverty Status2
Fewer disparities were found by MSA1,2,a,c:
Coverage by age 24 months among children born during 2019-2020 for the combined 7-vaccine series:
68.8% (67.0-70.6) — MSA Principal City
70.6% (68.7-72.4) — MSA Nonprincipal City
64.1% (60.9-67.4) — Non-MSA
Wide variations also occurred in vaccination coverage by state2:
Largest disparity for ≥ 2 doses of influenza vaccine, by age 24 months among children born during 2019-2020d with estimates ranging from:
33.0% (27.2–39.6) — Mississippi (N=505)
-TO-
85.9% (81.0–90.1) — Connecticut (N=466)
aNIS-Child uses random-digit-dialing to identify US households with children ages 19-35 months. A telephone survey is conducted with the parent or guardian who is most knowledgeable about the child’s immunization history, and consent is requested to contact the child’s vaccination providers. If consent is granted, a questionnaire is mailed to all the child’s vaccine providers to obtain vaccination information, which is synthesized to create the child’s comprehensive vaccination history. Data was collected for 27,733 children.1
bChildren’s health insurance status was reported by parent or guardian. “Other insurance” includes the Children’s Health Insurance Program, military insurance, coverage via the Indian Health Service, and any other type of health insurance not mentioned elsewhere.1
cMSA status was determined based on household-reported city and county of residence and grouped into three categories: MSA principal city, MSA nonprincipal city, and non-MSA. MSA and principal city were as defined by the US Census Bureau (https://www.census.gov/programs-surveys/metro-micro.html). Non-MSA areas included urban populations not located within an MSA, as well as completely rural areas.1
dDoses must be at least 24 days apart (4 weeks with a 4-day grace period); doses could have been received during two influenza seasons.2
MSA, Metropolitan Statistical Area.
See how your state measures up.
Are you a health care professional in a rural community?
“A strong recommendation from a health care provider is the single most important factor in determining whether or not someone gets vaccinated.”7
Understanding the impact of SDOH on adolescents in your community and taking appropriate action can help you work toward closing the vaccination gap in your practice.
3 simple but important steps:
- Make an effective vaccination recommendation for all appropriate adolescents.8
- Understand that parents may have concerns and prepared to address their questions.8
- Ensure consistent messaging among everyone in your practice about the importance of vaccines.8
SDOH in rural communities toolkit
More ways to help
References
- Hill HA, Yankey D, Elam-Evans LD, Chen M, Singleton JA. Vaccination coverage by age 24 months among children born in 2019 and 2020 — National Immunization Survey-Child, United States, 2020–2022. MMWR Morb Mortal Wkly Rep. 2023;72(44):1190–1196. doi: http://dx.doi.org/10.15585/mmwr.mm7244a3
- Hill HA, Yankey D, Elam-Evans LD, Chen M, Singleton JA. Vaccination coverage by age 24 months among children born in 2019 and 2020 — National Immunization Survey-Child, United States, 2020–2022. Supplemental Tables 1-3. MMWR Morb Mortal Wkly Rep. 2023;72(44):1190–1196. doi: http://dx.doi.org/10.15585/mmwr.mm7244a3
- Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA. Vaccination coverage by age 24 months among children born in 2018 and 2019 – National Immunization Survey-Child, United States, 2019-2021. Supplemental Tables 1-3. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585mmwr.mm7202a3
- Murthy BP, Zell E, Kirtland K, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations — 10 U.S. jurisdictions, March-September 2020. MMWR Morb Mortal Wkly Rep. 2021;70(23):840-845. doi:10.15585/mmwr.mm7023a2
- Schweiberger K, Patel SY, Mehrotra A, Ray KN. Trends in pediatric primary care visits during the coronavirus disease of 2019 pandemic. Acad Pediatr. 2021;21(8):1426-1433. doi:10.1016/ j.acap.2021.04.031
- Gillen EM, Donthi S, Sobel, E, Fix A, Finkel M, Frazier L. Vaccination rates among Medicaid adolescents declined during pandemic. Avalere. Published August 18, 2021. Accessed March 13, 2024. http://avalere.com/insights/vaccination-rates-among-medicaid-adolescents-declined-during-pandemic
- Centers for Disease Control and Prevention. Educate the parent and patient. Reviewed May 7, 2019. Accessed March 13, 2024. https://www.cdc.gov/vaccines/hcp/admin/educating-patients.html
- Centers for Disease Control and Prevention. Vaccination in rural communities. Reviewed April 21, 2023. Accessed March 13, 2024. https://www.cdc.gov/ruralhealth/vaccines/index.html