title: The association of health insurance and continuous primary care in the medical home on vaccination coverage for 19- to 35-month-old children.
abstract: OBJECTIVE
  Our goal was to examine the association of continuous care in the medical home and health insurance on up-to-date vaccination coverage by using data from the National Survey of Children's Health and the National Immunization Survey.
  
  
  METHODS
  Interviews were conducted with 5400 parents of 19- to 35-month-old children to collect data on demographics and medically-verified vaccinations. Health insurance coverage was categorized as always, intermittently, or uninsured for the previous 12 months. Insurance types were private, public, or uninsured. Having a personal doctor or nurse and receiving preventive health care in either the past 12 or 24 months constituted continuous primary care in the medical home. Children were up-to-date if they received all vaccinations by 19 to 35 months of age (>or=4 doses of diphtheria and tetanus toxoids and pertussis vaccine, >or=3 doses of poliovirus vaccine, >or=1 dose of any measles-containing vaccine, >or=3 doses of Haemophilus influenzae type b vaccine, and >or=3 doses of hepatitis B vaccine).
  
  
  RESULTS
  Bivariate analyses revealed children who were always insured had significantly higher vaccination coverage (83%) than those with lapses or uninsured during the past 12 months (75% and 71%, respectively). Those with continuous primary care in the medical home had significantly higher coverage than those who did not (83% vs 75%, respectively). In multivariate analysis, the same pattern of association was observed for insurance status and medical home, but the only statistically significant association was for children of never-married mothers who had significantly lower coverage (74%) compared with children of married mothers (84%).
  
  
  CONCLUSIONS
  Among children with the same insurance status and continuity of care in the medical home, children of single mothers were less likely to be up-to-date than children of married mothers. Interventions assisting single mothers to obtain preventive care for their children should be a priority.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Division of Immunization Services, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. nallred@cdc.gov
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Allred
authors.forename: Karen G
authors.initials: KG
authors.lastname: Wooten
authors.forename: Yuan
authors.initials: Y
authors.lastname: Kong
mesh_terms: D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States