Fu Linda Y, Cowan Nuala, McLaren Rosie, Engstrom Ryan, Teach Stephen J
Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA.
Pediatrics. 2009 Dec;124(6):1579-86. doi: 10.1542/peds.2009-0233. Epub 2009 Nov 23.
We examined the relationship between spatial accessibility to pediatric immunization providers and vaccination compliance in a low-income, urban population of children.
In 2007, we accessed the Washington, DC, Immunization Information System (IIS) to collect data on the immunization statuses and residential addresses of children who were aged 19 to 35 months and had Medicaid insurance. In addition, we calculated each child's spatial accessibility to pediatric vaccination providers by assessing the provider-to-population ratio at each residential address. Spatial accessibility was divided into tertiles (low, medium, and high) of access. The relationship between spatial accessibility to providers and vaccination compliance was examined by using logistic regression analysis adjusting for age, type of vaccination provider, and enrollment in child care status.
Overall for our cohort of 4195 children, 80.5% of the children were up-to-date with vaccinations. Vaccination coverage ranged from 61.6% to 100% (median: 79.2%) among different neighborhoods. Having the highest level of access to pediatric vaccination providers was associated with 36% higher odds of being up-to-date as compared with having the lowest level of access. The middle tertile of access was associated with 25% higher odds of being up-to-date.
Within our low-income, urban population, children with higher spatial accessibility to pediatric vaccination providers were more likely to be up-to-date with vaccinations. This association may guide future studies and efforts to ensure adequate immunization coverage for children regardless of where they live.
我们研究了低收入城市儿童群体中，儿童免疫接种服务提供者的空间可达性与疫苗接种依从性之间的关系。
2007年，我们访问了华盛顿特区免疫信息系统（IIS），以收集年龄在19至35个月且拥有医疗补助保险的儿童的免疫接种状况和居住地址数据。此外，我们通过评估每个居住地址的服务提供者与人口比例，计算了每个儿童对儿科疫苗接种服务提供者的空间可达性。空间可达性被分为可达性的三个等级（低、中、高）。通过逻辑回归分析，在对年龄、疫苗接种服务提供者类型和儿童保育状态登记进行调整后，研究了服务提供者的空间可达性与疫苗接种依从性之间的关系。
在我们的4195名儿童队列中，总体上80.5%的儿童疫苗接种及时。不同社区的疫苗接种覆盖率在61.6%至100%之间（中位数：79.2%）。与可达性最低的情况相比，对儿科疫苗接种服务提供者的可达性最高与疫苗接种及时的几率高36%相关。可达性中等的等级与疫苗接种及时的几率高25%相关。
在我们的低收入城市人口中，对儿科疫苗接种服务提供者空间可达性较高的儿童更有可能疫苗接种及时。这种关联可能为未来的研究和努力提供指导，以确保无论儿童居住在哪里，都能获得足够的免疫接种覆盖率。
