title: Rural childhood immunization. Rates and demographic characteristics.
abstract: BACKGROUND
  Childhood immunization rates are suboptimal, especially in high-risk populations. Rural residents could constitute a population at high risk for childhood underimmunization; little is known about demographic factors associated with childhood underimmunization. This study compared the immunization rates of urban and rural 2-year-olds and examined the association between demographic factors and underimmunization for rural 2-year-olds.
  
  
  METHODS
  We analyzed two nationally representative surveys: the 1991 National Maternal and Infant Health Survey (NMIHS) and the 1993 National Health Interview Survey (NHIS). The study population consisted of children in non-metropolitan statistical areas who were 24 to 36 months of age in the NMIHS and 19 months to 5 years of age in the NHIS. The NMIHS sample contained 4425 children (966 in rural areas) and the NHIS sample contained 2505 children (566 in rural areas).
  
  
  RESULTS
  There were no significant differences in immunization rates between rural and urban children. In urban areas, immunization rates were 63.3% (NMIHS) and 65.5% (NHIS) compared with 63.0% (NMIHS) and 67.8% (NHIS) in rural areas. Low income, low family education, nonwhite race, unemployment, and being a female child were associated with underimmunization in one or both data sets. These relationships were not modified by residence in a universal purchase state, where the state purchases and distributes vaccine for all children to reduce the cost and thereby improve access to immunization services.
  
  
  CONCLUSIONS
  Approximately one third of children in urban and rural areas were underimmunized. The demographic characteristics of underimmunized children were similar in urban and rural areas; however, the special characteristics of rural areas may require that interventions be tailored to rural needs.
authors.affiliation: University of Colorado Health Sciences Center, Denver, USA. lowery.elaine@tchden.org
authors.forename: N E
authors.initials: NE
authors.lastname: Lowery
authors.forename: E S
authors.initials: ES
authors.lastname: Belansky
authors.forename: C D
authors.initials: CD
authors.lastname: Siegel
authors.forename: J R
authors.initials: JR
authors.lastname: Goodspeed
authors.forename: C P
authors.initials: CP
authors.lastname: Harman
authors.forename: J F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014504:Urban Health