Learning from Kindergarteners — Uncovering Racial and Socioeconomic Disparities in Alaska's Vaccination Rates
METHODS: Alaska’s 4 largest districts provided medically-verified vaccination records for kindergarteners enrolled in 2013–2014. We graphed up-to-date DTaP vaccination coverage by age per the Advisory Committee on Immunization Practices schedule. We stratified analyses by race and free/reduced lunch eligibility (SES proxy). We calculated district-adjusted coverage rate differences (aCRD) within racial strata by SES and within SES strata by race.
RESULTS: The 7,304 records reviewed represented 69% of Alaska’s kindergarteners. DTaP vaccination coverage was 82% at 3 months (1 dose), 69% at 5 months (2 doses), 59% at 7 months (3 doses), and 54% at 19 months (4 doses). At 24 months, coverage improved to 69%, with differences by strata. Among American Indian/Alaska Native (AI/AN) children, SES did not significantly affect coverage. Among non-AI/ANs, high-SES children had higher coverage than low-SES children (aCRD: 11.9%; 95% confidence interval [CI]: 9.5%–14.3%). Among low-SES children, district modified the effect of race (p<0.01); AI/AN children had significantly higher coverage in 2/4 districts (aCRD: 16.4%; 95% CI: 11.3%–21.5%), with no significant difference elsewhere (aCRD: 2.5%; 95% CI: -5.6%–10.6%). Among high-SES children, race did not significantly affect coverage.
CONCLUSIONS: Socioeconomic and racial coverage disparities, along with drop-off in timely receipt of consecutive DTaP doses, underscore systemic gaps in Alaska’s vaccine delivery. Strategies for quality improvement include augmenting reminder/recall efforts and enhancing access to care for non-AI/AN children of lower SES.