Do changes in socio-demographic characteristics impact up-to-date immunization status between 3 and 24 months of age? A prospective study among an inner-city birth cohort in the United States

Abstract

Introduction: Low-income child populations remain under-vaccinated. Our objective was to determine differences in the relative importance of maternal health literacy and socio-demographic characteristics that often change during early childhood on up-to-date (UTD) immunization status among a low-income population. Methods: We performed secondary data analysis of a longitudinal prospective cohort study of 744 Medicaid-eligible mother-infant dyads recruited at the time of the infant's birth from an inner-city hospital in the United States and surveyed every 6 months for 24 months. Our primary outcome was infant UTD status at 24 months abstracted from a citywide registry. We assessed maternal health literacy with the Test of Functional Health Literacy in Adults (short version). We collected socio-demographic information via surveys at birth and every 6 months. We compared predictors of UTD status at 3, 7, and 24 months. Results: The cohort consisted of primarily African-American (81.5%) mothers with adequate health literacy (73.9%). Immunizations were UTD among 56.7% of infants at 24 months of age. Maternal health literacy was not a significant predictor of UTD immunization status. Instead, adjusted results showed that significant predictors of not-UTD status at 24 months were lack of a consistent health care location or "medical home" (OR 0.17, 95%CI 0.18-0.37), inadequate prenatal care (OR 0.48, 95%CI 0.25-0.95), and prior not-UTD status (OR 0.31,. Notably, all upper confidence limits are less than 1.0 for these variables. Health care location type (e.g., hospital-affiliate, community-based, none) was a significant predictor of vaccine status at age 3 months, 7 months, and 24 months. Conclusions: Investing in efforts to support early establishment of a medical home to obtain comprehensive coordinated preventive care, including providing recommended vaccines on schedule, is a prudent strategy to improve vaccination status at the population level.

Changes in parental barriers to immunizations

“…Conversely, in a more recent study prospective study, Pati et al. () found that maternal literacy and maternal education was not significantly associated with UTD immunization status at 24 months of age. Further study on the impact of maternal educational level on beliefs over time about the importance of immunizations and how these beliefs translate into UTD immunizations status through childhood is warranted.…”

Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers

“…Parents may also consider a child’s health status when making immunization decisions, but maternal perceptions of a child’s health has not been studied as a correlate of vaccine outcomes. Likewise, access to a consistent health care location has been identified as a predictor of up-to-date immunization status ( Pati et al, 2017 ), and studies have shown that underimmunized children have lower rates of preventive care visits ( Glanz et al, 2013 ), but it is uncertain whether vaccine perceptions are associated with the frequency of visits for pediatric health care.…”

Association of Discrimination and Health Care Experiences With Incomplete Infant Vaccination During COVID-19

“…While this study is limited by its self-selected sample and self-report data, it is strengthened by the prospective design and inclusion of an array of previously established and newly identified predictors. Since vaccination status in early infancy is overwhelmingly predictive of future up-to-date vaccination status, 5 strategies to address perinatal care limitations and discrimination merit serious consideration by policy makers, health care organizations, and obstetric and pediatric clinicians. 4,6 To promote infant vaccination, special attention should be given to vulnerable women who experienced financial loss or discrimination or had negative health care experiences.…”