Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Survey Methodology, Institute for Social Research, Ann Arbor, Michigan.
Am J Prev Med. 2021 Jan;60(1 Suppl 1):S65-S76. doi: 10.1016/j.amepre.2020.06.034. Epub 2020 Oct 21.
India's childhood vaccination coverage has increased amid the implementation of national health policies intended to improve immunization levels. However, there is a dearth of contemporary studies comparing state-level childhood vaccination rates across India's highly diverse states and territories. This study assesses SES-based inequalities in childhood vaccination by state for 2002-2013.
National surveys from 2002 to 2004, 2007 to 2008, and 2012 to 2013 were used for analyses. Household SES was assessed using an asset index created through principal component analysis. Full vaccination comprised 1 dose bacille Calmette-Guerin, 3 doses diphtheria-pertussis-tetanus vaccine, 3 doses oral polio vaccine, and 1 dose measles-containing vaccine at age 12-60 months. Inequality analyses were stratified by 3 time periods and by government-designated high focus group versus non-high focus group states.
Childhood vaccination steadily increased between 2002 and 2013 in high focus group states but fell in some non-high focus group states, whereas SES-based vaccination inequalities generally decreased in both. In 2012-2013, rural areas had lower vaccination rates than urban areas in high focus group states but similar vaccination rates as urban areas in non-high focus group states. Increases in vaccination rates were not consistently accompanied by improvements in SES-based inequalities in vaccination.
Childhood vaccination in India has improved overall, although increases are more pronounced in high focus group states than in non-high focus group states over the study period. The gap in coverage between these states decreased over time owing in part to the latter experiencing reductions in full vaccination rates during 2007-2013. SES-based vaccination disparities persist in India, highlighting the need to improve vaccination rates for all children, especially those from disadvantaged and underserved groups.
This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
随着旨在提高免疫水平的国家卫生政策的实施，印度的儿童疫苗接种覆盖率有所提高。然而，在高度多样化的邦和联邦属地之间，关于印度各州儿童疫苗接种率的当代研究却很少。本研究评估了 2002-2013 年按邦划分的儿童疫苗接种的基于社会经济地位的不平等现象。
利用 2002-2004 年、2007-2008 年和 2012-2013 年的全国性调查进行分析。家庭社会经济地位通过主成分分析创建的资产指数进行评估。完全接种包括在 12-60 个月龄时接种 1 剂卡介苗、3 剂白喉-百日咳-破伤风疫苗、3 剂口服脊髓灰质炎疫苗和 1 剂麻疹疫苗。不平等分析分为 3 个时期和政府指定的高重点组与非高重点组邦。
2002 年至 2013 年，高重点组邦的儿童疫苗接种率稳步上升，但一些非高重点组邦的接种率有所下降，而基于社会经济地位的疫苗接种不平等现象总体上在这两个组中都有所减少。2012-2013 年，高重点组邦的农村地区的疫苗接种率低于城市地区，而非高重点组邦的农村地区与城市地区的疫苗接种率相同。疫苗接种率的提高并不总是伴随着基于社会经济地位的疫苗接种不平等现象的改善。
印度的儿童疫苗接种总体上有所改善，尽管在研究期间，高重点组邦的增长更为明显。由于后者在 2007-2013 年期间经历了完全接种率的下降，这些邦之间的覆盖差距随着时间的推移而缩小。印度仍然存在基于社会经济地位的疫苗接种差异，这突出表明需要提高所有儿童，特别是弱势群体和服务不足群体的疫苗接种率。
本文是题为“全球疫苗公平性”的补充文章的一部分，该补充文章由密歇根大学公共卫生学院全球疫苗公平研究所赞助。
