Socioeconomic inequalities and vaccination coverage: results of an immunization coverage survey in 27 Brazilian capitals, 2007-2008, Brazil
Since 1988, Brazil’s Unified Health System has sought to provide universal and equal access to immunizations. Inequalities in immunization may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. We examined coverage with routine infant immunizations from a survey of Brazilian children according to socioeconomic stratum of residence census tract.
METHODS:
We conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the Federal District. We calculated coverage with recommended vaccinations among children until 18 months of age according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination.
RESULTS:
Among 17295 children with immunization cards, 14538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunized by 18 months of age versus 81.2% to 86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than census tracts with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant except to the higher stratus where the coverage is higher between the families with the lowest household wealth index.
CONCLUSIONS:
Evidence from Brazilian capitals shows success in achieving high immunization coverage among poorer children. Strategies are needed to reach children in wealthier areas.