Abstract
INTRODUCTION: A recent study has shown that the national-scale difference in immunization coverage between non-Hispanic white (abbreviated "white") and non-Hispanic African-American (abbreviated "African-American") children aged 19-35 months in the United States has increased by about 1 percentage point annually. We examined how this widening gap differs with geography and income. METHODS: We used data from the National Immunization Survey, 1998-2003, a national telephone survey. We examined differences between white and African-American children in immunization coverage within income groups (at or above versus below the federal poverty level) for each census region (northeast, south, midwest and west). We tested the hypothesis of constant disparity over time. RESULTS: Among households at or above the federal poverty level in the northeast census region, disparity is widening (white coverage minus African-American coverage was -0.5 in 1998 but 15.5 in 2003). Among household at or above the federal poverty level in the midwest census region, disparity is narrowing (white coverage minus African-American coverage was 13.9 in 1998 but 2.5 in 2003). We found no significant evidence of a trend in other groups. CONCLUSIONS: Widening national-level disparity in immunization coverage is primarily attributable to trends in the northeast census region. Addressing the widening disparity in coverage requires new strategies that consider current social and economic contexts.
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