Pediatric Academic Societies Abstracts for 2001

UNDERIMMUNIZATION AMONG AFRICAN-AMERICAN CHILDREN: NO EASY ANSWERS JA Taylor, PM Darden, DA Brooks, AB Bocian and RC Wasserman. Pediatrics, University of Washington, Seattle, WA; Pediatrics, Medical University of South Carolina, Charleston, SC; Pediatrics, Johns Hopkins University, Baltimore, MD; Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL; and Pediatrics, University of Vermont, Burlington, VT. Accepted for a presidential plenary presentation at the 2001 Pediatric Academic Societies? Annual Meeting.

OBJECTIVE: To assess the immunization status of African American (AA) children followed by practicing pediatricians in the US.

DESIGN/METHODS: The study was conducted by PROS and the National Medical Association (NMA membership is largely AA physicians). Practitioners collected immunization data on consecutively seen children, 8-35 months old. Parents completed a questionnaire indicating their child's ethnicity, mother's education level, possible barriers to obtaining vaccinations, and preferences for their child receiving needed immunizations during a visit for a mild illness. Study children were considered fully immunized at 8 months if they had received all recommended vaccines prior to that age. Immunization status of AA and non-AA children was compared using bivariate analyses; the risk of underimmunization among AA children was assessed using logistic regression, adjusting for maternal education level, practice location (inner-city or other), and year of child's birth.

RESULTS: Immunization data were collected by 177 practitioners in 46 states on 13,520 children. At 8 months of age, 68.3% of 2,052 AA children were fully immunized vs. 81.4% of non-AA patients (P < .001). AA children were significantly less likely to be fully immunized than non-AA children in both PROS and NMA practices (P<.001 and P=.0003, respectively), and in practices in the inner-city (P< .001). After controlling for confounders, the OR for AA children being underimmunized was 1.59 (95% CI 1.39, 1.82). Parents of AA children were significantly less likely than those of non-AA children to identify barriers to immunization (29.8% vs. 32.6%, P=.012), and were more likely to prefer receiving needed vaccines during an illness visit (49.9% vs. 44.9%, P=.00005).

CONCLUSIONS: Underimmunization of AA children is not readily explained by maternal education, differences in ethnicity between providers and patients, parental identification of barriers to vaccination, or parental attitudes. The immunization needs of AA children need to be better met by the health care system.

DISCLOSURE: Funding from CDC, National Immunization Program, and HRSA, Maternal and Child Health Bureau.