Peer-reviewed article
Uncovering Gaps in Childhood Vaccine Coverage: A Post-COVID-19 Analysis of Vaccine Disparities in Tennessee.
Sanjaya Regmi, Elizabeth Sowell, Chenoa Allen, Benjamin E Jones, Clea McNeely et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined childhood vaccination rates across Tennessee from July 2022 to May 2024, surveying nearly 9,000 parents or caregivers. Overall vaccination rates were high at 96.5%, but significant disparities emerged across racial and ethnic groups, insurance status, and geography. Children without health insurance, those of multiracial or Asian/Native Hawaiian/Pacific Islander descent, and younger children had lower vaccination rates. The findings point to specific gaps in vaccine coverage that require targeted outreach to underserved communities.
Key points
- Overall 96.5% of children in Tennessee reported up-to-date vaccination status
- Uninsured children had significantly higher under-vaccination rates (10.4%) compared to insured children (2.9%)
- Lowest vaccination rates were among children of multiracial (86.4%) and Asian/Native Hawaiian/Pacific Islander (90.3%) parents
- Insurance status, race, and child age were consistently associated with under-vaccination in both rural and urban areas
- Parental education was significant only in urban areas, and household income only in rural areas
Limitations
This study relies on parent-reported vaccination status rather than verified medical records, which may introduce reporting bias. The cross-sectional design cannot establish causation and findings are specific to Tennessee, limiting generalisability to other regions.
Abstract
PurposeTo examine the association between sociodemographic determinants and parent-reported up-to-date childhood vaccination status in Tennessee.DesignCross-sectional statewide survey.SettingAll 95 Tennessee counties, July 2022 to May 2024. Surveys were distributed at community outreach events (health fairs, Head Start programs, community baby showers), and community organizations (schools, daycares, and preschools).SampleParents or caregivers of children aged 18 years and younger (N = 8954).MeasuresThe primary outcome was parent-reported up-to-date childhood vaccination status. Covariates included child's age, health insurance status, parental race/ethnicity and education, household income, and rural/urban residency.AnalysisDescriptive statistics and log-binomial regression models were used to assess associations between sociodemographic factors and vaccination status. Stratified analyses were conducted by rural and urban status. Adjusted prevalence (aP) and 95% confidence intervals (CIs) with robust estimates were reported.ResultsOverall, 96.5% reported that their children were up-to-date on vaccinations. The lowest vaccination rates were observed among children of multiracial (86.4%), and Asian/Native Hawaiian/Pacific Islander (90.3%) parents. Children without health insurance had a significantly higher prevalence of under-vaccination (aP = 0.104; 95% CI, 0.079-0.137) compared to insured children (aP = 0.029; 95% CI, 0.025-0.033). Across both rural and urban areas, under-vaccination was significantly associated with insurance, race, and child age, while parental education was significant only in urban areas and household income only in rural areas.ConclusionsFindings highlight critical gaps in vaccine coverage tied to insurance, race, and age. Targeted outreach to underserved and low-education communities is needed to promote equity in childhood vaccination.