Abstract
Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural–urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural–urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24–35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural–urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children’s birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women’s illiteracy, targeted at migrant children or children from minority ethnicities.
Highlights
A remarkable success in vaccination coverage has been observed globally, but significant disparities still exist between or within countries [1,2,3]
There was a significant overrepresentation of higher birth order numbers and migrant children
In rural areas, there was an over-representation of women who were under 30 years of age, with lower education levels, with no job, from minority ethnics, and from households with a lower monthly income
Summary
A remarkable success in vaccination coverage has been observed globally, but significant disparities still exist between or within countries [1,2,3]. The analysis of determinants explaining the difference in vaccination coverage between communities can help increase the FVC by decreasing the inequalities in coverage. Determinants influencing vaccination coverage have been widely studied in developing countries, and similar risk factors were found to explain both vaccination coverage and disparities therein. Socioeconomic and demographic characteristics of mothers or children, accessibility to vaccination service, information, and belief-related factors have been observed as determinants of the vaccination coverage [4,5]. Zhejiang province, located in east China, is one of the most developed provinces in the mainland of China, with a population of 72 million based on the 2015 census.
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