Department of Pediatrics, Denver Health Medical Center, Denver, Colorado;
Departments of Pediatrics.
Pediatrics. 2019 Dec;144(6). doi: 10.1542/peds.2019-2710. Epub 2019 Nov 4.
Forty-five states permit religious exemptions to school immunization laws; 15 allow personal belief exemptions. Updated religious exemption estimates are lacking, and it is unclear if personal belief exemption availability impacts religious exemption rates. We aimed to (1) update religious exemption trends in kindergartners, (2) compare states' proportions of kindergartners with religious exemptions by personal belief exemption availability, and (3) describe whether the proportion of kindergartners with religious exemptions changed in Vermont after it eliminated personal belief exemptions in 2016.
We analyzed Centers for Disease Control and Prevention data on exemptions for children entering kindergarten from 2011 to 2018, including 295 state-years in our final analysis. Using a quasi-binomial regression analysis, we compared mean proportions of kindergartners with religious exemptions in states allowing both nonmedical exemptions against states with religious exemptions only, adjusting for policy strength and school year.
States with religious and personal belief exemptions were one-fourth as likely to have kindergartners with religious exemptions as states with religious exemptions only (risk ratio 0.25; 95% confidence interval 0.16-0.38). After Vermont's policy change, the mean proportion of kindergartners with a religious exemption increased from 0.5% to 3.7%. States were significantly more likely to have kindergartners with religious exemptions during the 2017-2018 school year compared with the 2011-2012 school year ( = .04).
Religious exemption rates appear to be associated with personal belief exemption availability, may be subject to a replacement effect on personal belief exemption elimination, and are increasing. Researchers and policy makers should confirm findings with individual-level studies and reconsider the purpose and nature of religious exemption laws.
45 个州允许学校免疫法的宗教豁免；15 个州允许个人信仰豁免。缺乏最新的宗教豁免估计数据，也不清楚个人信仰豁免的可用性是否会影响宗教豁免率。我们旨在：(1) 更新幼儿园宗教豁免趋势；(2) 通过个人信仰豁免的可用性比较各州幼儿园有宗教豁免的比例；(3) 描述 2016 年佛蒙特州取消个人信仰豁免后，幼儿园有宗教豁免的比例是否发生变化。
我们分析了 2011 年至 2018 年儿童进入幼儿园的疾病控制和预防中心豁免数据，包括我们最终分析中的 295 个州年。使用拟二项回归分析，我们比较了允许非医疗豁免和仅宗教豁免的州中幼儿园有宗教豁免的平均比例，调整了政策力度和学年。
有宗教和个人信仰豁免的州，幼儿园有宗教豁免的儿童比例是只有宗教豁免的州的四分之一（风险比 0.25；95%置信区间 0.16-0.38）。佛蒙特州政策变化后，幼儿园有宗教豁免的儿童比例从 0.5%上升到 3.7%。与 2011-2012 学年相比，2017-2018 学年各州幼儿园有宗教豁免的儿童比例显著更高（ =.04）。
宗教豁免率似乎与个人信仰豁免的可用性有关，可能受到个人信仰豁免消除的替代效应的影响，而且正在增加。研究人员和政策制定者应该通过个体水平的研究来证实这些发现，并重新考虑宗教豁免法的目的和性质。
