Abstract
BackgroundThe Netherlands has experienced epidemics of vaccine preventable diseases largely confined to the Bible belt, an area where -among others- orthodox protestant groups are living. Lacking information on the vaccination coverage in this minority, and its various subgroups, control of vaccine preventable diseases is focused on the geographical area of the Bible belt. However, the adequacy of this strategy is questionable. This study assesses the influence of presence of various orthodox protestant subgroups (orthodox protestant denominations, OPDs) on municipal vaccination coverage in the Bible belt.MethodsWe performed an ecological study at municipality level. Data on number of inhabitants, urbanization level, socio-economical status, immigration and vaccination coverage were obtained from national databases. As religion is not registered in the Netherlands, membership numbers of the OPDs had to be obtained from church year books and via church offices. For all municipalities in the Netherlands, the effect of presence or absence of OPDs on vaccination coverage was assessed by comparing mean vaccination coverage. For municipalities where OPDs were present, the effect of each of them (measured as membership ratio, the number of members proportional to total number of inhabitants) on vaccination coverage was assessed by bivariate correlation and multiple regression analysis in a model containing the determinants immigration, socio-economical status and urbanization as well.ResultsMean vaccination coverage (93.5% ± 4.7) in municipalities with OPDs (n = 135) was significantly lower (p < 0.001) than in 297 municipalities without OPDs (96.9% ± 2.1). Multiple regression analyses showed that in municipalities with OPDs 84% of the variance in vaccination coverage was explained by the presence of these OPDs. Immigration had a significant, but small explanatory effect as well. Membership ratios of all OPDs were negatively related to vaccination coverage; this relationship was strongest for two very conservative OPDs.ConclusionAs variance in municipal vaccination coverage in the Bible belt is largely explained by membership ratios of the various OPDs, control of vaccine preventable diseases should be focused on these specific risk groups. In current policy part of the orthodox protestant risk group is missed.
Highlights
The Netherlands has experienced epidemics of vaccine preventable diseases largely confined to the Bible belt, an area where -among others- orthodox protestant groups are living
Lacking information on the vaccination coverage in the orthodox protestant minority and its various subgroups, currently control of vaccine preventable diseases is focused on the geographical area of the Bible belt
In order to achieve the aim of the study, the following research questions were formulated: Is there a difference in vaccination coverage between municipalities with and without orthodox protestant denominations (OPDs)? What is the influence of the membership ratios of separate OPDs on municipal vaccination coverage in municipalities where OPDs are present?
Summary
The Netherlands has experienced epidemics of vaccine preventable diseases largely confined to the Bible belt, an area where -among others- orthodox protestant groups are living. Lacking information on the vaccination coverage in this minority, and its various subgroups, control of vaccine preventable diseases is focused on the geographical area of the Bible belt. Lacking information on the vaccination coverage in the orthodox protestant minority and its various subgroups, currently control of vaccine preventable diseases is focused on the geographical area of the Bible belt. The term Bible belt is generally understood as the area where the orthodox Protestants are living, the boundaries of this area are not exactly clear It is often defined as municipalities with votes for the Staatkundig Gereformeerde Partij (SGP, the orthodox protestant political party) above a certain threshold, mostly 5% [5]. Knowledge of vaccination coverage in the orthodox protestant minority, and its various subgroups, could be helpful to focus prevention and control of vaccine preventable diseases at the persons really at risk
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