Association between time-appropriate vaccinations in early childhood and individual and community-level factors in Japan

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  • OSAWA Eri
    Department of International Health and Collaboration, National Institute of Public Health Department of Environmental and Occupational Health, Toho University Graduate School of Medicine
  • AKIYAMA Yuka
    Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi
  • SHINOHARA Ryoji
    Department of Health Sciences, Health Science University
  • OJIMA Toshiyuki
    Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
  • IMAMURA Haruhiko
    Department of Environmental and Occupational Health, Toho University Graduate School of Medicine Department of Environmental and Occupational Health, School of Medicine, Toho University
  • ASAKURA Keiko
    Department of Environmental and Occupational Health, Toho University Graduate School of Medicine Department of Environmental and Occupational Health, School of Medicine, Toho University
  • NISHIWAKI Yuji
    Department of Environmental and Occupational Health, Toho University Graduate School of Medicine Department of Environmental and Occupational Health, School of Medicine, Toho University
  • OOKA Tadao
    Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi
  • YAMAGATA Zentaro
    Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi

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Other Title
  • 乳幼児期における適切な時期の予防接種行動に関連した個人レベルおよび地域レベル要因の検討
  • ニュウヨウジキ ニ オケル テキセツ ナ ジキ ノ ヨボウ セッシュ コウドウ ニ カンレン シタ コジン レベル オヨビ チイキ レベル ヨウイン ノ ケントウ

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Abstract

<p>Objective　Recently, in Japan, the compulsory vaccinations administered during early childhood have been becoming increasingly varied. As a result, the vaccination schedule has become complicated. In this study, we aimed to identify the association of time-appropriate vaccination during early childhood (dependent variable) with individual-level factors including socioeconomic status and having a family doctor. We also studied the association of time-appropriate vaccination with community-level factors including the number of pediatricians in a community.</p><p>Methods　Multilevel logistic regression models were used for analysis. Time-appropriate BCG, DPT, and measles vaccinations were the dependent variables. Individual-level data were obtained through a survey of parents of 18-month-old children as part of the final evaluation of “Healthy Parents and Children 21”; community-level data were obtained through a survey of municipalities as part of the aforementioned final evaluation as well as through a national survey. There were 23,583 parents in 430 municipalities who were eligible for analysis.</p><p>Results　Time-appropriate vaccination of infants was carried out by 88.3% of parents. The results of the multilevel logistic regression showed that time-appropriate vaccination was significantly lower for those who did not have a family doctor (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.36-0.55), the fourth or later birth order (0.23; 0.19-0.28), mothers aged less than 19 years at childbirth (0.17; 0.13-0.24), full-time working mothers (0.52; 0.47-0.58), and those under very difficult economic conditions (0.66; 0.57-0.77). Among community-level factors, only use of vaccination data by a municipality had a significantly negative association with the dependent variable.</p><p>Conclusion　Not having a family doctor, the mother's young age, late birth order, poor economic status, and full-time working mothers were risk factors associated with delayed vaccinations. It is necessary to improve environments that promote infants having a family doctor as well as to promote special approaches toward families at risk for delayed vaccinations.</p>

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