title: Insurance status and vaccination coverage among US preschool children.
abstract: BACKGROUND
  Insurance status has been shown to have an impact on children's use of preventive and acute health services. The objective of this study was to determine the relationship between insurance status and vaccination coverage among US preschool children aged 19 to 35 months.
  
  
  METHODS
  We linked data from 2 national telephone surveys, the National Immunization Survey and the National Survey of Early Childhood Health, conducted during the first half of 2000. Children were considered up to date (UTD) when they had received at least 4 diphtheria-tetanus-acellular pertussis/diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 MMR vaccine, 3 Haemophilus influenza vaccines, and 3 hepatitis B vaccines at the time the interview was conducted.
  
  
  RESULTS
  Among the 735 children in our study sample, 72% were UTD. The vast majority (94%) reported some type of health insurance at the time of the survey. Children with private insurance were more likely to be UTD (80%) than those with public insurance (56%) or no insurance (64%). In a multivariate analysis that controlled for child's race/ethnicity; household income; maternal age/marital status/educational level; location of usual care; and Special Supplemental Nutrition Program for Women, Infants, and Children participation, insurance was no longer an independent predictor of vaccination.
  
  
  CONCLUSIONS
  The disparity in vaccination coverage among publicly, privately, and uninsured children is dramatic, underscoring its importance as a marker for underimmunization, despite the multivariate findings. The Vaccines for Children Program, a partnership between public health and vaccination providers who serve uninsured children and those enrolled in Medicaid, is well suited to target and improve vaccination coverage among these vulnerable children.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jsantoli@cdc.gov
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Santoli
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Huet
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.forename: Lance E
authors.initials: LE
authors.lastname: Rodewald
authors.forename: Moira
authors.initials: M
authors.lastname: Inkelas
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Olson
authors.forename: Neal
authors.initials: N
authors.lastname: Halfon
mesh_terms: D002675:Child, Preschool; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008484:Medicaid; D017057:Medically Uninsured; D015999:Multivariate Analysis; D011632:Public Assistance; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*