Wood D, Donald-Sherbourne C, Halfon N, Tucker M B, Ortiz V, Hamlin J S, Duan N, Mazel R M, Grabowsky M, Brunell P
RAND (Santa Monica, CA), USA.
Pediatrics. 1995 Aug;96(2 Pt 1):295-301.
To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children.
Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach.
South Central and East Los Angeles areas in inner-city Los Angeles.
Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age.
Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral polio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine).
Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors.
Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, 0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90).
Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors' offices or health maintenance organization/managed care plans.
确定低收入城市中心拉丁裔和非裔美国学龄前儿童在3个月和24个月时疫苗接种不足的相关因素。
采用横断面、多阶段、整群抽样设计结合重复配额抽样方法，对城市中心家庭的代表性样本进行访谈。
洛杉矶市中心的中南部和东部地区。
817个有12至36个月大孩子的拉丁裔家庭和387个非裔美国家庭。
在3个月时（1剂白喉-破伤风-百日咳疫苗和1剂口服脊髓灰质炎疫苗）以及24个月时（4剂白喉-破伤风-百日咳疫苗、3剂口服脊髓灰质炎疫苗和1剂麻疹-腮腺炎-风疹疫苗）完全免疫或疫苗接种最新（UTD）。
根据人群和医疗保健系统因素，对3个月和24个月时UTD免疫状态进行逻辑回归分析。
70%的拉丁裔儿童和53%的非裔美国儿童在3个月大时达到UTD。在24个月大时，42%的拉丁裔儿童和26%的非裔美国儿童免疫接种达到UTD。3个月前接受首次免疫接种与家庭规模较小以及有产前护理的证据相关。如果拉丁裔儿童从私立医疗机构而非公立诊所获得儿童健康护理，那么他们在24个月时达到UTD的可能性较小（优势比[OR]=0.45，95%置信区间[CI]=0.26，0.79）。如果拉丁裔儿童参加健康维护组织而非公立诊所，也存在免疫接种情况较差的趋势（0.31，0.05<P<0.1）。如果非裔美国儿童在3个月时达到UTD（OR=5.56，95%CI=1.43，21.6）、有更多次健康就诊（OR=1.13，95%CI=1.01，1.27），那么他们在24个月时达到UTD的可能性更大；如果他们参加医疗补助计划而非私人保险，那么在24个月时达到UTD的可能性较小（OR=0.26，95%CI=0.08，0.90）。
洛杉矶市中心的非裔美国儿童和拉丁裔儿童在3个月和24个月时的免疫接种率都很低。产前护理和家庭规模与3个月时达到UTD密切相关；然而，家庭和儿童特征对24个月时达到UTD的预测作用相对较小。在所研究的城市中心低收入社区中，2岁时免疫接种不足的重要风险因素包括健康保险类型和儿童健康护理来源，公立部门的接种率高于私人医生办公室或健康维护组织/管理式医疗计划。
