Online Program

Disparities in childhood vaccination coverage: Findings of the National Immunization Survey (NIS), 2013

Tuesday, November 3, 2015 : 4:30 p.m. - 4:48 p.m.

Laurie D. Elam-Evans, PhD, MPH, Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA
Holly Hill, MD, PhD, Assessment Branch, Centers for Disease Control and Prevention, Immunization Services Division, Atlanta, GA
David Yankey, MS, Assessment Branch, Centers for Disease Control and Prevention, Immunization Services Division, Atlanta, GA
Maureen Kolasa, MPH, Program Operations Branch, Centers for Disease Control and Prevention, Atlanta, GA

Childhood vaccination coverage is monitored by the Centers for Disease Control and Prevention to provide national, state and selected local area coverage estimates, to assess progress towards Healthy People 2020 targets, and to identify sociodemographic disparities.


NIS is a dual-frame random-digit-dialed telephone survey, with follow up immunization history questionnaires (IHQs) mailed to vaccination providers. The parents of children 19-35 months were sampled from landlines and cell phones in the 50 states, District of Columbia, and selected local areas. Telephone interviews were used to obtain demographic information and request consent to contact the child’s provider(s) to obtain vaccination histories. Household interview and provider-reported data were analyzed using SUDAAN to examine vaccination coverage levels by race/ethnicity and poverty status. Data were weighted to be representative of the population of children 19-35 months. Logistic regression was used to examine differences among racial/ethnic populations, controlling for poverty status. Statistical analyses were conducted using t-tests, using weighted data and accounting for the complex survey design.


In 2013, children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for all childhood vaccines, with percentage point differences ranging from 3.7% to 12.6%.   Additionally, black children had significantly lower vaccine coverage compared to white children for >4 doses diphtheria tetanus and acellular pertussis vaccine (DTap; 74.7% vs 85.3%), full series of haemophilus influenzae type b vaccine (Hib; 74.9% vs 84.2%), >4 doses pneumococcal vaccine (PCV; 76.1% vs 84.1%), rotavirus vaccine (62.1% vs 74.8%), and the combined 7-vaccine series (65.0% vs 72.1%). After adjustment for poverty status, this racial/ethnic disparity was reduced but remained statistically significant, except for the combined 7-vaccine series.


This disparity in vaccination coverage signals that more interventions or policy-related efforts are needed for identified subgroups. Additional analyses should be conducted to better understand poverty and racial/ethnic disparities, including an examination of health insurance status, number of children in household, maternal education and marital status, and state-level factors. These analyses can help inform evidence-based interventions.  Disparities in vaccination coverage must be addressed to protect all children from vaccine-preventable diseases.

Learning Areas:


Learning Objectives:
Describe the two phases of data collection used in the National Immunization Survey. Describe at least one health disparity identified in vaccination coverage.

Keyword(s): Health Disparities/Inequities, Immunizations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I earned a MPH in Epidemiology from Emory University and a PhD in Epidemiology from the University of North Carolina at Chapel Hill. Additionally I have worked at the Centers for Disease Control and Prevention for more than 20 years in various content areas. I currently work as Lead Health Scientist for the National Immunization Survey (NIS) and NIS-Teen.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.