Abstract
The National Immunization Survey (NIS) is the United States’ primary tool for assessing immunization coverage among 19- to 35-monthold children. Although annual estimates from the NIS are quite precise at the national level, US State-level estimates have much larger sampling error than national-level estimates. We combined two independent unbiased estimates of US State-level coverages within a given year to obtain new estimates which are more precise than previously published estimates. We first calculated a model-based estimate for each State for 2001 using multiple years of NIS data. Next, we combined each model-based estimate with the corresponding, previously reported NIS estimate for 2001. Our resulting estimates of State-level immunization coverage had smaller standard errors than the previously published estimates. To make similar improvements in precision by increasing sample size would, depending on State, require an increase in sample size of 30% – 120%.
Highlights
Childhood immunizations in the United States have made rare many diseases that once caused enormous morbidity and mortality
Maintaining high rates of immunization in each new birth cohort is the key to continued success; coverage among infants and young children is monitored by the National Immunization Survey (NIS), which estimates coverage nationally, for the 51 US States, and for selected urban areas
At the level of US States and urban areas, which have smaller sample sizes than the national estimate, standard errors are of size up to 3 percentage points
Summary
Childhood immunizations in the United States have made rare many diseases that once caused enormous morbidity and mortality. Maintaining high rates of immunization in each new birth cohort is the key to continued success; coverage among infants and young children is monitored by the National Immunization Survey (NIS), which estimates coverage nationally, for the 51 US States (we treat the District of Columbia as a State, resulting in one more State than the usual 50), and for selected urban areas. The NIS produces annual estimates of immunization coverage for each geographic area considered. Annual NIS coverage estimates are quite precise, with standard errors smaller than 0.5 percentage points. At the level of US States and urban areas, which have smaller sample sizes than the national estimate, standard errors are of size up to 3 percentage points.
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