Researchers used spatial analysis software and electronic health records to identify clusters of under-immunization and vaccine refusal among Kaiser Permanente members in northern California.

A study published in the journal Pediatrics reviewed the immunization records of more than 154,000 Kaiser Permanente Northern California members between birth and 3 years old. All the children were born between 2000 and 2011 and were covered continuously by Kaiser Permanente, which provides healthcare for about 40 percent of the insured population in 13 northern California counties.

To identify the clusters of under-immunization and vaccine refusal, researchers used sophisticated spatial analysis software, which allowed them to examine health factors in relation to geography. Under-immunization ranged from 18 percent to 23 percent within clusters, compared with 11 percent outside clusters.

“This research confirms anecdotal reports of under-immunization clusters,” said Tracy A. Lieu, M.D., the study’s lead author. “In addition, we found clusters in places we hadn’t anticipated.”

Lieu noted that this study will be useful for targeting outreach efforts in particular areas, although it was not designed to figure out why children in some areas are less likely to be fully immunized.

Lieu said the research, part of a larger study on parent preferences and vaccination funded by the Patient-Centered Outcomes Research Institute, was the first to use the spatial analysis technique with real-time vaccination data.

“Everyone in the Kaiser Permanente healthcare system has access to vaccines, and since childhood vaccination is covered by insurance, financial barriers are not an issue,” Lieu said. “Our findings raise awareness that there may be communities where parents have more vaccine hesitancy and may be interested in more information or more in-depth conversations with their children’s doctors.”

The study is available here.

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