Published online August 6, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e535-e542 (doi:10.1542/peds.2006-3296)
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ARTICLE

Identifying Risk Factors for Underimmunization by Using Geocoding Matched to Census Tracts: A Statewide Assessment of Children in Hawaii

Sara J. Whitehead, MD, MPHa,b, Kate X. Cui, MD, MPHb, Anindya K. De, PhD, MStata, Tracy Ayers, MSb and Paul V. Effler, MD, MPHb

a Preventive Medicine Residency Program, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
b Disease Outbreak and Control Division, Hawaii State Department of Health, Honolulu, Hawaii

OBJECTIVE. Obtaining childhood immunization coverage data for small geographic areas is difficult and resource-intensive, especially in the absence of comprehensive immunization registries. To identify factors that are associated with delayed immunization, we collected school-entry immunization records statewide and used geocoding to link to publicly available census tract sociodemographic data.

METHODS. Immunization records were reviewed for children who were enrolled in all public and private school kindergarten programs in Hawaii in the 2002–2003 school year; immunization status at the time of the second birthday was determined. The main outcome variable was up-to-date status for the 4:3:1:3:3 vaccination series (4 doses of diphtheria-tetanus-pertussis, 3 doses of polio, 1 dose of measles-mumps-rubella, 3 doses of Haemophilus influenzae type b, and 3 doses of hepatitis B vaccines). Children's home addresses were geocoded to census tracts; coverage rates by tract were mapped, and sociodemographic data from Census 2000 files were used to identify factors that were associated with delays in immunization.

RESULTS. Records were obtained for 15275 of 15594 children registered in Hawaii kindergartens. Overall, 78% had completed their 4:3:1:3:3 series by their second birthday. Risk factors for delayed immunization included delayed immunization at 3 months of age, living in Maui County, living in a neighborhood where a low proportion of adults had postsecondary education, and living in a neighborhood where a high proportion of households spoke a language other than English at home. The majority (80%) of underimmunized children would have required only 1 additional visit to bring them up-to-date.

CONCLUSIONS. Retrospective review of kindergarten-entry immunization data revealed geographic areas with lower immunization coverage, and geocoding to census tracts identified associated sociodemographic risk factors. This is a practical method for state or city health departments to identify pockets of need and to direct resources appropriately.

Key Words: immunization rates • preschool child • child health services • immunization programs

Abbreviations: NIS—National Immunization Survey • USGS—United States Geological Survey • DTP—diphtheria-tetanus-pertussis vaccine • MMR—measles-mumps-rubella vaccine • Hib—Haemophilus influenzae type b vaccine • hepB— hepatitis B vaccine • OR—odds ratio • CI—confidence interval

Accepted Mar 16, 2007.