title: Childhood immunizations in China: disparities in health care access in children born to North Korean refugees.
abstract: BACKGROUND
  Childhood immunization rates are at an all-time high globally, and national data for China suggests close to universal coverage. Refugees from North Korea and their children may have more limited health care access in China due to their legal status. However, there is no data on immunization rates or barriers to coverage in this population.
  
  
  METHODS
  This study was conducted to determine the rates and correlates of immunizations in children (≥1 year) born to North Korean refugees in Yanbien, China. Child immunization data was obtained from vaccination cards and caregiver self-report for 7 vaccines and 1:3:3:3:1 series. Age-appropriate vaccination rates of refugee children were compared to Chinese and migrant children using a goodness-of-fit test. Logistic regression was used to determine correlates of immunization coverage for each vaccine and the 1:3:3:3:1 series.
  
  
  RESULTS
  Age-appropriate immunization coverage rates were significantly lower in children born to North Korean refugees (12.1-97.8 %), compared to Chinese (99 %) and migrant (95 %) children. Increased father's age and having a sibling predicted significantly lower vaccination rates.
  
  
  CONCLUSIONS
  Children born to North Korean refugees had significantly lower immunization rates, compared to Chinese or migrant children. Further research is needed to examine barriers of health care access in this high-risk population.
authors.affiliation: Cornell University, Ithaca, NY, USA. hc473@cornell.edu.|Yonsei University College of Medicine, 50-1 YonseiRo SeodaemunGu, 120-752, Seoul, South Korea. hc473@cornell.edu.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Chung
authors.affiliation: Department of Environment and Health Science, Soonchunhyang University, Asan-si, South Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Health Systems and Outcomes, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
authors.forename: Hyerang
authors.initials: H
authors.lastname: Kim
authors.affiliation: Cornell University, Ithaca, NY, USA.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Finkelstein
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China; D056911:Democratic People's Republic of Korea / Q000208:ethnology; D005260:Female; D014943:Global Health; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006806:Human Rights; D006801:Humans; D017589:Immunization Programs / Q000592:standards; D007223:Infant; D008297:Male; D012036:Refugees; D011795:Surveys and Questionnaires; D014171:Transients and Migrants; D019472:Universal Health Insurance; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: Child health; Health disparities; Immunization; North Korean refugees in China