The relationship between income per capita and access to meningococcal serogroup B vaccination in Spain: an ecological correlation study

Abstract

Background: Invasive meningococcal disease (IMD) remains a public health concern because of its serious consequences, which mainly affect infants and young children. In Spain, Neisseria meningitidis serotype B accounts for >40% of IMD cases. The multicomponent meningococcal serogroup B vaccine (4CMenB) is available privately in the absence of national public funding in Spain. This study evaluates whether potential inequities in access to 4CMenB exist among families because of financial disparities. Methods: An ecological correlation study was carried out using aggregate birth data, average income per capita and average number of 4CMenB vaccine units dispensed at province and municipal levels, including municipalities with >50,000 inhabitants. The base-case scenario used birth data from 2018, 4CMenB uptake from March 2018 to February 2019 and income per capita from 2017. The Spearman correlation test was used to compute bivariate correlation coefficients (rs) between the ratio of 4CMenB uptake per birth and income per capita. Sensitivity analyses were carried out to study the impact of observational period, territorial assignment and target population on base-case results. Results: At province level, no correlation between mean income per capita and 4CMenB units was observed. At municipality level, a statistically significant positive correlation was observed between 4CMenB uptake per birth and average income per capita (rs = 0.22; p = 0.007). The results were robust under sensitivity analyses. Conclusions: Despite the low level of granularity, these results suggest that access to the 4CMenB vaccine in Spain is associated with the income level of families at municipal level, producing inequities in the context of no national public funding. Keywords: Ecological correlation study, Meningococcal serogroup B vaccine, Vaccine uptake in Spain, Inequities in vaccine access, Financial impact.