Are there social inequalities in children’s access to vaccination in France? Examples of vaccination against pneumococcal infections and BCG vaccination

Introduction and Objectives: In France, social inequalities in childhood vaccination have rarely been studied. We conducted a survey to determine whether there were specific socioeconomic determinants of childhood vaccination with BCG and pneumococcal conjugate vaccines. Method: This was a cross-sectional survey of children aged 0 to 5 years living in Paris and the Paris metropolitan area, selected through a three-stage stratified random sampling process. Data were collected via face-to-face interviews. Vaccination coverage (VC) for BCG and heptavalent pneumococcal conjugate vaccine (PCV7), confirmed by documentation, was estimated. Poisson regressions were used to analyze the association between vaccination coverage and certain socioeconomic and demographic factors. Results: VC for BCG was 82.7%. VCOs for PCV7 were 93.7% (n=203) for a single dose and 76.7% for the complete primary vaccination series (n=179). Among children from the lowest-income families, VCOs for BCG were high and close to 100%, regardless of the parents’ origin. Among children from higher-income families, the BCG vaccination coverage was higher among children born to families from countries with high tuberculosis endemicity (98.2%) than among other children (76.2%) (p=0.004). The vaccination coverage for the "single-dose" PCV7 among children from families with the lowest incomes was lower than that of families with higher incomes (83.2% vs. 97.3%, p=0.033). A similar result (though not statistically significant) was observed for complete primary vaccination (65.5% vs. 87.6%, p=0.09). Complete vaccination coverage was lower among children with basic health coverage (70.2%) than among children with supplemental insurance through CMUc/AME (81.4%) or private/mutual insurance (76.1%), but these differences were not significant. Conclusions: Children from low socioeconomic backgrounds, as well as those from countries with high tuberculosis endemicity—regardless of their family’s socioeconomic status—are adequately vaccinated with BCG. The association between low vaccination coverage for PCV7 and low income suggests the existence of financial barriers in the poorest families, but the lack of a significant association with the type of health coverage could also indicate the existence of barriers other than purely financial ones, more closely linked to adherence or access to vaccination among disadvantaged populations. (R.A.)

Author(s): Guthmann JP, Chauvin P, Le Strat Y, Soler M, Fonteneau L, Levy Bruhl D

Publishing year: 2014

Pages: 346-51

Weekly Epidemiological Bulletin, 2014, n° 20, p. 346-51

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