title: Is there an association between the coverage of immunisation boosters by the age of 5 and deprivation? An ecological study.
abstract: OBJECTIVE
  To determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  Routinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD).
  
  
  METHODS
  Primary Care Trust (PCT) areas in England between 2007/08 and 2010/11.
  
  
  METHODS
  Population coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5.
  
  
  RESULTS
  Over the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period (r=-0.298, p<0.001 in 2007/08 and r=-0.179, p=0.028 in 2010/11). This was similar for the second MMR in 2007/08 (r=-0.225, p=0.008) and 2008/09 (r=-0.216, p=0.008) but there was no statistically significant correlation in 2009/10 (r=-0.108, p=0.186) or 2010/11 (r=-0.078, p=0.343).
  
  
  CONCLUSIONS
  Lower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. Electronic address: mzyhs1@nottingham.ac.uk.
authors.forename: Helena
authors.initials: H
authors.lastname: Sandford
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. Electronic address: laila.tata@nottingham.ac.uk.
authors.forename: Laila J
authors.initials: LJ
authors.lastname: Tata
authors.affiliation: Leicester City Council, Public Health Directorate, New Walk Centre, Leicester, LE1 6ZG, UK. Electronic address: Ivan.Browne@leicester.gov.uk.
authors.forename: Ivan
authors.initials: I
authors.lastname: Browne
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. Electronic address: Catherine.pritchard@nottingham.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pritchard
mesh_terms: D002675:Child, Preschool; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D004363:Drug Utilization; D004739:England; D005260:Female; D006801:Humans; D007117:Immunization, Secondary / Q000706:statistics & numerical data; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D012959:Socioeconomic Factors
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022542:Measles-Mumps-Rubella Vaccine
keywords: Children; Ecological study; England; Immunisation; Index of multiple deprivation