Factors associated with low uptake of measles and pertussis vaccines - An ecologic study based on the Australian Childhood Immunisation Register

Abstract

Objective: To evaluate the relationships between socio-economic and demographic variables and low immunisation coverage at the national level. Methods: The Australian Childhood Immunisation Register (ACIR) contains data at the postcode level on the immunisation status of all children registered with Medicare under the age of seven years. The Australian Bureau of Statistics (ABS) produces a number of indicators of socio-economic status at the postcode level from Census data. These and other ABS demographic data were used to examine the relationship between immunisation coverage and various socio-demographic indicators. Results: Factors associated with lower immunisation uptake differed in rural and metropolitan areas. High levels of education and occupation and a high proportion of Aboriginal residents were significantly associated with lower coverage only in metropolitan postcodes. High unemployment was associated with lower immunisation coverage only in rural postcodes. A high proportion of late starters to immunisation was the strongest single predictor of coverage and was important in rural and metropolitan postcodes. A high proportion of overseas-born persons and of GP-delivered immunisations was also associated with lower coverage in all areas. Conclusions: These data suggest that in metropolitan areas, reasons for low uptake in more advantaged areas require further evaluation. In non-metropolitan areas, low coverage was associated with areas of disadvantage, for which access to services may be more important. Implications: Children who are late in starting the schedule should be targeted.