Community coalition contributions to improving child vaccination rates in New York

Background: Provider-based interventions appear inadequate to reduce the persistent gap in immunization coverage between children of color and white children. Method: We used a quasi- experimental, matching birth cohort design to evaluate the impact of a community-based intervention of outreach, reminders, and tracking for children <5 years of age in a Latino, low-income community in New York City. We compared immunization coverage rates for children participating in the immunization program with those for children of the same hospital birth cohort and resident in the community who did not participate in the program. Comparisons were done for 4 annual birth cohorts (1999-2003) for children aged 19-35 months of age at the assessment date. Immunization data (4:3:1:3:3 series) were obtained from the New York Citywide Immunization Registry. Chi-square and t- tests were used to assess for significant differences in coverage; logistic regressions estimated the relative contribution of race/ethnicity, Medicaid, and intervention to immunization coverage. Results: Across all four annual cohorts, 8.2% of the children (n=895) were in the intervention. Children in the intervention had 8-13% significantly higher immunization coverage than children in the control group. After controlling for race/ethnicity and insurance status, children in the intervention were 53% more likely to be up-to-date than children not in the intervention (AOR: 1.53; 95% CI 1.33-1.75). Medicaid status and race/ethnicity did not significantly affect immunization coverage. Conclusions: Our study shows that community-based interventions can play an important role in eliminating immunization disparities.