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Table 1 Vaccination coverage in infants and preschoolers with respect to parental SES and primary care models

From: Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia – a systematic review

Author, Year Setting, Study design, and population Data source(s) Outcome(s) Measurement of parental SES (# of categories) Overall Vaccination coverage (%) Key findings (narrative) Risk of bias
Hierarchical with well-baby clinic
Pearce, 2015 [19] Australia, National Sample, Cross-sectional 2004, n = 4994 Survey and health records MMR and DTP combined as part of a series of vaccinations - Area Level SES (5)
- Parental Income (4)
- Maternal Education (6)
90.7 There was no association between being unvaccinated and area level SES or parental income.
Compared to the highest educated group, the odds of being non-vaccinated was 1.63 (1.04–2.55) for the lowest educated group. There was no significant difference for the rest of the groups.
Medium
van Lier, 2014 [16] Netherlands, National sample, Cross-sectional 2005–2006, n = 180 456 National register MMR and DTP combined as part of a series of vaccinations Area level SES (4) 94.5 Areas with lowest SES had only slightly lower vaccination uptake (a difference of 1.9%) compared to areas with highest SES.
Higher SES area was associated with higher odds of full vaccination uptake, and lower SES area was associated with lower uptake.
Low
Wallby, 2013 [18] Sweden, Regional sample (Uppsala), Longitudinal
1998–2006, n = 25 024
Regional register MMR separately and DTP as part of a series of vaccinations Parental income (4) 92.9 (MMR)
98.5 (DTP)
Both for MMR and DTP only the lowest SES group had slightly lower vaccination rates, 3.4 and 1.9% difference respectively, when compared to the highest SES group. Overall, the findings showed no influence of parental income on vaccination uptake. Low
Hierarchical without well-baby clinic
Borras, 2007 [15] Spain, regional sample (Catalonia), Cross-sectional 2003–2004, n = 630 Telephone survey and vaccination cards MMR and DTP combined as part of a series of vaccinations -Maternal education(2)
-Parental occupation(2)
95.4 Maternal education variable was dichotomized based on university degree and the odds of being vaccinated was 1.84 (1.01–3.33) for higher educated (with a 6%more coverage rate). No association was found for parental occupation. Medium
Jessop, 2010 [36] Ireland, Regional sample (Dublin and Galway), Cross sectional 2007, n = 749 Survey and health records MMR - Maternal education (2)
- Parental income (2)
88.7 Children of mothers with higher level of education had 2.1% lower immunization coverage compared to mothers with secondary or lower level education. Their odds of lacking MMR immunization was 1.48 (1.01–2.04)
Immunization coverage was 8% lower for children in families that < 300£ per week, compared to families with an income > = 300£. The odds of lacking MMR vaccination was 1.60 (1.35–1.90) for children of parents with low income.
Medium
Doherty, 2014 [21] Ireland, National sample, Cross sectional 2008–2009, n = 9581 Survey DTP as part of a series of vaccinations - Maternal Education (2)
- Parental occupation (4)
92.0 Neither maternal education nor household occupation were found to be associated with risk of non-vaccination. Medium
Pearce, 2008 [20] United Kingdom, National sample, Longitudinal 2000–2002, n = 14 578 Survey and health records MMR Maternal Education (7) 88.6 Children of mothers with A/AS level or degree had higher risk of being unimmunized when compared to mothers with no education. There was no significant association for other groups. Medium
Hungerford, 2016 [17] United Kingdom, Regional sample (Liverpool), Longitudinal 1997–2012, n = 62 689 Regional register MMR Area level SES (5) 88.4 The least deprived SES group had 6% higher vaccination coverage compared to the most deprived SES group. The risk of being unimmunized for MMR increased linearly with increasing deprivation. Low
Non-hierarchical with well-baby clinic
Theeten, 2007 and Vandermeulen, 2008 [12, 13] Belgium, Regional sample (Flanders), Cross sectional 2005, n = 1349 Survey MMR - Parental income (5)
- Maternal Education (3)
94.0 No significant association was found between family income and MMR vaccination.
Parental education was found to be an insignificant factor for MMR coverage.
Medium
Non-hierarchical without well-baby clinic
Fonteneau, 2013 [22] France, National sample, Cross sectional n = 21 346 Survey and health records MMR Parental Occupation (7) 43.3 The group with lowest vaccination coverage was children of farmers (33%). Rest of the groups had 8–13% higher vaccination coverage. However, only three groups (intermediate professions, employees and qualified workers) had significantly higher odds of being vaccinated (OR 1.4), when compared to the children of farmers. Medium
Mikolajczyk, 2008 [24] Germany, Regional sample (Bavaria), Cross sectional 2004–05, n = 2043 Survey and health records MMR Parental Education (3) 1. both parents with low education,
2. One parent with high education
3. Both parents with high education.
93.0 Almost 9% of the children with two high-educated parents and 5% of children with only one highly educated parent were unimmunized. Compared to the group with both parents having high education, the other two groups had lower odds of being unimmunized for MMR. The association was only significant for the children with one parent having high education. Medium
Poethko-Muller, 2009 [25] Germany, National Sample, Longitudinal 2003–06, n = 14 826 Survey data and vaccination cards. MMR (Measles) Parental education (3) 93.6 Children with high SES background were 3% less vaccinated compared to children in low and mid SES group. Adjusted Odds ratios showed no association between socioeconomic status and vaccination. Medium
Rosenkotter, 2012 [37] Germany, Regional sample (North Rhine-Westfalia), Cross sectional 2007, n = 52 171 Survey and school-screening program MMR and DTP combined as part of a series of vaccinations Parental Education (3) 41.3 Compared to the group with high educated parents, children of parents with low education had 6% lower coverage and double the odds of having incomplete vaccination uptake. There were no significant differences between children with high and medium educated parents. Medium
Danis, 2010 [23] Greece, National Sample, Cross sectional 2004–05, n = 3878 Survey and vaccination card MMR and DTP combined as part of a series of vaccinations Maternal education (4) 63.8 65% of children of mothers with high-school degree and 69% of children of mothers with university degree were completely vaccinated as compared to 54% of children of low educated mothers. Children of mothers with a degree of high school or above had higher odds of being vaccinated compared to the children of mothers with less than 9 years of education. Medium
Anello, 2017 [26] Italy, 2 Regional samples (Friuli-Venezia/Giulia [FVG] and Emilia-Romagna [ER]), Longitudinal 1995–2011, n = 48 454 Regional
register
MMR (separate) and DTP (as part of a series of vaccinations) Maternal Education (3) FVG:
MMR(89.5)
DTP (98.2)
ER:
MMR (87.9)
DTP (97.7)
For MMR, the coverage overall was similar across the groups. In FVG, children of mothers with less than high school education had 3% higher vaccination rates compared to mothers with university degree. In both regions, children of mothers with university degree had higher risk of being unvaccinated when compared to the lowest educated group.
For DTP, the coverage was same across all groups. In FVG region, children of mothers with high school degree or higher had risk of being unvaccinated.
Low