Klevens R M, Luman E T
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Prev Med. 2001 May;20(4 Suppl):41-6. doi: 10.1016/s0749-3797(01)00281-1.
Poverty and factors associated with poverty are strong and persistent barriers to childhood immunization. Substantive differences in coverage with basic vaccinations have been consistently observed over time between children living in poverty and those who are not.
The National Immunization Survey (NIS) uses a random-digit-dialing sample of telephone numbers in each state and in 28 urban areas. The NIS provides vaccination coverage information representative of all U.S. children aged 19 to 35 months. We categorized children in the NIS using Bureau of Census categories of poverty as follows: "above poverty" for household income > or = 125% of the federal poverty threshold for the household's size and composition; "near poverty," 100% to <125% of the poverty threshold; "intermediate poverty," 50% to <100% of the poverty threshold; and "severe poverty," <50% of the poverty threshold. We described coverage with basic vaccinations from 1996 through 1999 by poverty category and compare coverage between children in poverty and above poverty.
From 1996 to 1999, estimated vaccination coverage with the basic vaccine series was consistently higher among children living above the poverty level than all other children. The difference in estimated vaccination coverage between children living in severe poverty and those living above poverty was 13.6 percentage points in 1996, and 10.0 percentage points in 1999. Vaccination coverage with the series 4:3:1:3 among children living in near poverty was similar to that of children living in poverty (74.7% vs 73.3%, p=0.52). Estimated vaccination coverage increased significantly (p<0.05) between 1996 and 1999 for most antigens among children living above poverty and among those living in intermediate and severe poverty. Vaccination coverage among children living in poverty increased significantly (p<0.05) between 1996 and 1999 in 1 of the 28 urban areas in the NIS.
Low vaccination coverage among children living in and near poverty is a persistent problem in the United States. Additional efforts are needed to improve coverage.
贫困以及与贫困相关的因素是儿童免疫接种的强大且持续存在的障碍。随着时间的推移，一直观察到贫困儿童与非贫困儿童在基本疫苗接种覆盖率方面存在实质性差异。
国家免疫接种调查（NIS）采用每个州和28个城市地区的随机数字拨号电话号码样本。NIS提供代表所有19至35个月大美国儿童的疫苗接种覆盖率信息。我们使用人口普查局的贫困类别对NIS中的儿童进行如下分类：家庭收入≥家庭规模和构成对应的联邦贫困线125%的儿童为“高于贫困线”；贫困线的100%至＜125%的儿童为“接近贫困线”；贫困线的50%至＜100%的儿童为“中度贫困”；贫困线＜50%的儿童为“重度贫困”。我们按贫困类别描述了1996年至1999年基本疫苗接种的覆盖率，并比较了贫困儿童与高于贫困线儿童之间的覆盖率。
1996年至1999年期间，生活在贫困线以上的儿童中基本疫苗系列的估计接种覆盖率一直高于所有其他儿童。1996年，生活在重度贫困中的儿童与生活在贫困线以上的儿童之间估计接种覆盖率的差异为13.6个百分点，1999年为10.0个百分点。生活在接近贫困线的儿童中4:3:~1:3系列疫苗的接种覆盖率与贫困儿童相似（74.7%对73.3%，p = 0.52）。1996年至1999年期间，生活在贫困线以上以及中度和重度贫困中的儿童中，大多数抗原的估计接种覆盖率显著增加（p＜0.05）。在NIS的28个城市地区中的1个地区，1996年至1999年期间贫困儿童的疫苗接种覆盖率显著增加（p＜0.05）。
生活在贫困线及接近贫困线的儿童中疫苗接种覆盖率低是美国一个长期存在的问题。需要做出更多努力来提高覆盖率。
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