Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.
OBJECTIVE
To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization.


METHODS
We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers.


METHODS
Age-appropriate immunizations and preventive health care visits.


RESULTS
By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age.


CONCLUSIONS
Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.
Guyer
B
B
Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Hughart
N
N
Holt
E
E
Ross
A
A
Stanton
B
B
Keane
V
V
Bonner
N
N
Dwyer
D M
DM
Cwi
J S
JS
D015142:Baltimore; D002675:Child, Preschool; D015331:Cohort Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007115:Immunization Schedule; D008458:Measles Vaccine / Q000627:therapeutic use; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000627:therapeutic use; D011054:Poliovirus Vaccine, Inactivated / Q000627:therapeutic use; D011204:Poverty Areas; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012411:Rubella Vaccine / Q000627:therapeutic use; D015983:Selection Bias; D014504:Urban Health; D014611:Vaccination / Q000706:statistics & numerical data*
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D004338:Drug Combinations; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D011054:Poliovirus Vaccine, Inactivated; D012411:Rubella Vaccine