A hierarchical analysis of social determinants of measles vaccination coverage in Austrian schoolchildren

Abstract

Background: Numerous socio-economic and demographic factors have been identified as being associated with low vaccination coverage in children. However, the complex interrelation between these factors is not fully understood. We focused our study on the less well-established associations of familial resources for child care with vaccination coverage and their interrelationship with socio-demographic factors. Methods: This cross-sectional study (n = 2386) focuses on parental social status and on resources for child care as determinants of measles vaccination coverage of schoolchildren aged 6-13 years in Styria, Austria. In order to reveal the relationships among these factors, an analysis based on a conceptual hierarchical model was performed. The so-called graphical modelling approach was used for the multivariate analysis of the hierarchically structured determinants. Results: The findings indicate that vaccination coverage is directly associated with a large number of children in the family (P < 0•0001) and directly as well as indirectly associated with a low level of education of the father (P < 0•001). All other included child-care resources are only indirectly associated with a low coverage, whereby the number of children acts as main mediating factor. Conclusions: The results suggest that vaccination programmes should mainly focus on families with many children or parents of low educational level and not on the whole population. © 2009 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.