Lowery N E, Belansky E S, Siegel C D, Goodspeed J R, Harman C P, Steiner J F
University of Colorado Health Sciences Center, Denver, USA.
J Fam Pract. 1998 Sep;47(3):221-5.
Childhood immunization rates are suboptimal, especially in high-risk populations. Rural residents could constitute a population at high risk for childhood underimmunization; little is known about demographic factors associated with childhood underimmunization. This study compared the immunization rates of urban and rural 2-year-olds and examined the association between demographic factors and underimmunization for rural 2-year-olds.
We analyzed two nationally representative surveys: the 1991 National Maternal and Infant Health Survey (NMIHS) and the 1993 National Health Interview Survey (NHIS). The study population consisted of children in non-metropolitan statistical areas who were 24 to 36 months of age in the NMIHS and 19 months to 5 years of age in the NHIS. The NMIHS sample contained 4425 children (966 in rural areas) and the NHIS sample contained 2505 children (566 in rural areas).
There were no significant differences in immunization rates between rural and urban children. In urban areas, immunization rates were 63.3% (NMIHS) and 65.5% (NHIS) compared with 63.0% (NMIHS) and 67.8% (NHIS) in rural areas. Low income, low family education, nonwhite race, unemployment, and being a female child were associated with underimmunization in one or both data sets. These relationships were not modified by residence in a universal purchase state, where the state purchases and distributes vaccine for all children to reduce the cost and thereby improve access to immunization services.
Approximately one third of children in urban and rural areas were underimmunized. The demographic characteristics of underimmunized children were similar in urban and rural areas; however, the special characteristics of rural areas may require that interventions be tailored to rural needs.
儿童免疫接种率未达最佳水平，尤其是在高危人群中。农村居民可能是儿童免疫接种不足的高危人群；关于与儿童免疫接种不足相关的人口统计学因素知之甚少。本研究比较了城市和农村2岁儿童的免疫接种率，并研究了农村2岁儿童的人口统计学因素与免疫接种不足之间的关联。
我们分析了两项具有全国代表性的调查：1991年全国母婴健康调查（NMIHS）和1993年全国健康访谈调查（NHIS）。研究人群包括非大都市统计区的儿童，在NMIHS中为24至36个月大，在NHIS中为19个月至5岁。NMIHS样本包含4425名儿童（农村地区966名），NHIS样本包含2505名儿童（农村地区566名）。
农村和城市儿童的免疫接种率没有显著差异。在城市地区，免疫接种率分别为63.3%（NMIHS）和65.5%（NHIS），而农村地区分别为63.0%（NMIHS）和67.8%（NHIS）。低收入、低家庭教育水平、非白人种族、失业以及女童在一个或两个数据集中都与免疫接种不足有关。这些关系并未因居住在普遍购买疫苗的州而改变，在这些州，政府为所有儿童购买和分发疫苗以降低成本，从而改善免疫接种服务的可及性。
城乡约三分之一的儿童免疫接种不足。免疫接种不足儿童的人口统计学特征在城乡相似；然而，农村地区的特殊特征可能需要根据农村需求调整干预措施。
