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Social Determinant
Poverty and the Childhood Immunization Rate
The literature appears to support that the social determinant of poverty has a detrimental impact on the level of immunization of children between 0 and 3 years of age. The National Immunization Survey (NIS) provides vaccination coverage information for all children in the U.S. aged between 19 and 35 months. A study by Klevens and Luman (2001) used this data to measure the impact of poverty on immunization rates. Defining poverty according to the federal thresholds, this study found that those living above poverty had consistently higher levels of uptake of immunization than those living below the poverty threshold. The study did however find that the difference appears to be declining, with a gap of 13.6 percentage points in 1996, reduced to 10.0 percentage points in 1999. This may be associated with differing trends in both levels of poverty and general levels of immunization take-up. Between 1995 and 2003 the level of immunization in the U.S. increased from 52.3 to 79.8%, while the number of children living in poverty dropped by 17.3% (Becton et al., 2008). This still does not explain why there are lower levels of immunization among the poor in the first instance however.
Becton et al. (2008) observed that having no health insurance dramatically lowered levels of vaccine uptake. This is likely to be associated with the impact poverty has on vaccine uptake, as it is those in poverty who are least likely to have health insurance (DeNavas-Walt et al., 2006). It may therefore be concluded that children between 0 and 3 years old from families living in poverty have lower levels of immunization; this is most likely to be due to lower levels of health insurance coverage among families in poverty.
References
Becton, J.L., Cheng, L. & Nieman, L. (2008). The effect of lack of insurance, poverty and pediatrician supply on immunization rates among young children 19-35 months of age in the United States. Journal of Evaluation of Clinical Practice, 14(2): 248-253.
DeNavas-Walt, C., Proctor, B.D. And Hill Lee, C. (2006). U.S. Census Bureau, Current Population Reports, P60-231, Income, Poverty, and Health Insurance Coverage in the United States: 2005, U.S. Government Printing Office, Washington, DC.
Klevens, R.M. & Luman, E.T. (2001). U.S. children living in and near poverty: Risk of vaccine-preventable diseases. American Journal of Preventative Medicine, 20(4 Suppl. 1): 41-46.
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