title: Maternal characteristics and hospital policies as risk factors for nonreceipt of hepatitis B vaccine in the newborn nursery.
abstract: BACKGROUND
  A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV.
  
  
  METHODS
  A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV.
  
  
  RESULTS
  A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49-1.85; >$75,000 vs. <$15,000: adjusted OR = 1.21, 95% CI = 1.13-1.30). Lack of a hospital policy stipulating a universal birth dose strongly predicted nonreceipt of a birth dose of HBV (policy with no birth dose vs. policy with a birth dose: adjusted OR = 2.21, 95% CI = 2.13-2.30).
  
  
  CONCLUSIONS
  Maternal characteristics such as higher education and income are associated with nonreceipt of the HBV during the perinatal period. To effectively reduce risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.
authors.affiliation: Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA. sean.o'leary@childrenscolorado.org
authors.forename: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.forename: Christina
authors.initials: C
authors.lastname: Nelson
authors.forename: Julie
authors.initials: J
authors.lastname: Duran
mesh_terms: D000328:Adult; D003120:Colorado; D005260:Female; D006291:Health Policy; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009725:Nurseries, Hospital; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D012307:Risk Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D017325:Hepatitis B Vaccines