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More than one-third of America's children lacked proper immunizations in the early 1990s

More than one-third of children from both urban and rural areas lacked the immunizations recommended for their ages in 1991 and 1993. Both groups of under-immunized children tended to come from families with lower incomes and fewer years of education, and they were more likely to belong to a minority group. Despite increased rural immunization rates since the early 1990s, pockets of need remain, concludes a study supported by the Agency for Health Care Policy and Research (contract 290-93-0039). Also, the unique characteristics of rural areas, such as fewer physicians and poorer families who are more likely to lack health insurance, may require that interventions be specially tailored to rural needs, according to the study.

Researchers from the University of Colorado Health Sciences Center and the Center for Health Policy and Services Research, Denver, calculated immunization rates of rural and urban 2-year-old boys and girls by analyzing two nationally representative surveys: the 1991 National Maternal and Infant Health Survey (NMIHS) of 4,425 children (966 in rural areas) and the 1993 National Health Interview Survey (NHIS) of 2,505 children (566 in rural areas). They found no significant differences in immunization rates between urban and rural children, with NMIHS rates of 63.3 percent versus 63 percent, respectively and NHIS rates of 65.5 percent and 67.8 percent, respectively.

However, low income, low family education, black or other minority race, unemployment, and female sex were associated with under-immunization in one or both surveys. These under-immunization figures did not change even for children residing in States that purchased and distributed vaccines for all children to reduce cost and improve access to immunization.

See "Rural childhood immunization: Rates and demographic characteristics," by N. Elaine Lowery, J.D., M.S.P.H., Elaine S. Belansky, Ph.D., Carol D. Siegel, M.D., M.S.P.H., and others, in the Journal of Family Practice 47(3), pp. 221-225, 1998.

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