PEDIATRICS Vol. 119 Supplement February 2007, pp. S4-S11 (doi:10.1542/peds.2006-2089C)
SUPPLEMENT ARTICLE |
The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children
National Center for Immunization and Respiratory Diseases (proposed), Division of Immunization Services, Centers for Disease Control and Prevention, Atlanta, Georgia
OBJECTIVE. Our goal was to examine the association of continuous care in the medical home and health insurance on up-to-date vaccination coverage by using data from the National Survey of Children's Health and the National Immunization Survey.
METHODS. Interviews were conducted with 5400 parents of 19- to 35-month-old children to collect data on demographics and medically-verified vaccinations. Health insurance coverage was categorized as always, intermittently, or uninsured for the previous 12 months. Insurance types were private, public, or uninsured. Having a personal doctor or nurse and receiving preventive health care in either the past 12 or 24 months constituted continuous primary care in the medical home. Children were up-to-date if they received all vaccinations by 19 to 35 months of age (
4 doses of diphtheria and tetanus toxoids and pertussis vaccine, 3 doses of poliovirus vaccine, 1 dose of any measles-containing vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine).
RESULTS. Bivariate analyses revealed children who were always insured had significantly higher vaccination coverage (83%) than those with lapses or uninsured during the past 12 months (75% and 71%, respectively). Those with continuous primary care in the medical home had significantly higher coverage than those who did not (83% vs 75%, respectively). In multivariate analysis, the same pattern of association was observed for insurance status and medical home, but the only statistically significant association was for children of never-married mothers who had significantly lower coverage (74%) compared with children of married mothers (84%).
CONCLUSIONS. Among children with the same insurance status and continuity of care in the medical home, children of single mothers were less likely to be up-to-date than children of married mothers. Interventions assisting single mothers to obtain preventive care for their children should be a priority.
Key Words: vaccination • health insurance • continuity of patient care
Abbreviations: VFC—Vaccines for Children • UTD—up-to-date • NSCH—National Survey of Children's Health • NIS—National Immunization Survey • CDC—Centers for Disease Control and Prevention • WIC—Special Supplemental Nutrition Program for Women, Infants, and Children • OR—odds ratio • CI—confidence interval • 4:3:1:3:3—4 doses of diphtheria and tetanus toxoids and pertussis vaccine, 3 doses of poliovirus vaccine, 1 dose of any measles-containing vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine
Accepted Sep 15, 2006.
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