Socioeconomic inequalities and measles immunization coverage in Ecuador: A spatial analysis

María Fernanda Rivadeneira; Sérgio Luiz Bassanesi; Sandra Costa Fuchs

doi:10.1016/j.vaccine.2018.07.051

Socioeconomic inequalities and measles immunization coverage in Ecuador: A spatial analysis

María Fernanda Rivadeneira^*
, Sérgio Luiz Bassanesi
, Sandra Costa Fuchs

^*Corresponding author for this work

Faculty of Health and Wellness

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Introduction/Background: Inequalities in measles immunization coverage facilitate the onset of outbreaks. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods: An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador, in 2011, and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador. Vaccinated children were considered those who received at least one dose of vaccine against measles. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. The slope index of inequality and the relative index of inequality were calculated. Results: Vaccination coverage against measles was inversely associated with unsatisfied basic needs in urban areas (P < 0.01) and the proportions of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. The non-immunization rate was 71% higher in the poorer cantons than in the upper stratum cantons (prevalence ratio 1.71; 95%CI: 1.69–1.72). A difference of 10.6 percentage points was detected in immunization coverage between cantons with the best vs. worst socioeconomic level, according to the slope index of inequality. The relative index of inequality revealed that immunization coverage was 1.12 times higher in cantons with the highest socioeconomic level vs. cantons with the lowest socioeconomic level. Conclusions: The spatial dependence between measles vaccination coverage and socioeconomic disparities suggests clusters of vulnerable populations for outbreaks. Health and social inequalities must be considered to achieve and maintain measles elimination.

Original language	English
Pages (from-to)	5251-5257
Number of pages	7
Journal	Vaccine
Volume	36
Issue number	35
DOIs	https://doi.org/10.1016/j.vaccine.2018.07.051
State	Published - 23 Aug 2018

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Ltd

Funding

Brazilian funding agencies CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) sponsored the Doctoral Fellowship of M.F.R. (Graduate Student Exchange Program – PEC-PG) at the Universidade Federal do Rio Grande do Sul Graduate Program in Epidemiology. The sponsors had no participation in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Brazilian funding agencies CAPES (Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior) and CNPq (Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico) sponsored the Doctoral Fellowship of M.F.R. (Graduate Student Exchange Program ? PEC-PG) at the Universidade Federal do Rio Grande do Sul Graduate Program in Epidemiology. The sponsors had no participation in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Funders
Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Universidade Federal do Rio Grande do Sul

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 1 No Poverty
SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities

Keywords

Epidemiological monitoring
Health care disparities
Measles-containing vaccine
Socioeconomic factors

Access to Document

10.1016/j.vaccine.2018.07.051

Cite this

@article{ed9b8b11d1844fffa37b7b5653edaeaa,

title = "Socioeconomic inequalities and measles immunization coverage in Ecuador: A spatial analysis",

abstract = "Introduction/Background: Inequalities in measles immunization coverage facilitate the onset of outbreaks. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods: An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador, in 2011, and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador. Vaccinated children were considered those who received at least one dose of vaccine against measles. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. The slope index of inequality and the relative index of inequality were calculated. Results: Vaccination coverage against measles was inversely associated with unsatisfied basic needs in urban areas (P < 0.01) and the proportions of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. The non-immunization rate was 71\% higher in the poorer cantons than in the upper stratum cantons (prevalence ratio 1.71; 95\%CI: 1.69{\textendash}1.72). A difference of 10.6 percentage points was detected in immunization coverage between cantons with the best vs. worst socioeconomic level, according to the slope index of inequality. The relative index of inequality revealed that immunization coverage was 1.12 times higher in cantons with the highest socioeconomic level vs. cantons with the lowest socioeconomic level. Conclusions: The spatial dependence between measles vaccination coverage and socioeconomic disparities suggests clusters of vulnerable populations for outbreaks. Health and social inequalities must be considered to achieve and maintain measles elimination.",

keywords = "Epidemiological monitoring, Health care disparities, Measles-containing vaccine, Socioeconomic factors",

author = "Rivadeneira, \{Mar{\'i}a Fernanda\} and Bassanesi, \{S{\'e}rgio Luiz\} and Fuchs, \{Sandra Costa\}",

note = "Publisher Copyright: {\textcopyright} 2018 Elsevier Ltd",

year = "2018",

month = aug,

day = "23",

doi = "10.1016/j.vaccine.2018.07.051",

language = "English",

volume = "36",

pages = "5251--5257",

journal = "Vaccine",

issn = "0264-410X",

publisher = "Elsevier B.V.",

number = "35",

}

TY - JOUR

T1 - Socioeconomic inequalities and measles immunization coverage in Ecuador

T2 - A spatial analysis

AU - Rivadeneira, María Fernanda

AU - Bassanesi, Sérgio Luiz

AU - Fuchs, Sandra Costa

PY - 2018/8/23

Y1 - 2018/8/23

N2 - Introduction/Background: Inequalities in measles immunization coverage facilitate the onset of outbreaks. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods: An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador, in 2011, and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador. Vaccinated children were considered those who received at least one dose of vaccine against measles. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. The slope index of inequality and the relative index of inequality were calculated. Results: Vaccination coverage against measles was inversely associated with unsatisfied basic needs in urban areas (P < 0.01) and the proportions of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. The non-immunization rate was 71% higher in the poorer cantons than in the upper stratum cantons (prevalence ratio 1.71; 95%CI: 1.69–1.72). A difference of 10.6 percentage points was detected in immunization coverage between cantons with the best vs. worst socioeconomic level, according to the slope index of inequality. The relative index of inequality revealed that immunization coverage was 1.12 times higher in cantons with the highest socioeconomic level vs. cantons with the lowest socioeconomic level. Conclusions: The spatial dependence between measles vaccination coverage and socioeconomic disparities suggests clusters of vulnerable populations for outbreaks. Health and social inequalities must be considered to achieve and maintain measles elimination.

AB - Introduction/Background: Inequalities in measles immunization coverage facilitate the onset of outbreaks. This study aimed to quantify socioeconomic inequalities associated with measles immunization coverage at the population level. Methods: An ecological study was performed using two datasets: the results of a measles immunization survey performed in Ecuador, in 2011, and socioeconomic data from the 2010 census, aggregated by canton. The survey included 3,140,799 people aged 6 months to 14 years living in 220 cantons of Ecuador. Vaccinated children were considered those who received at least one dose of vaccine against measles. Multiple spatial regression was performed to identify socioeconomic inequalities associated with measles immunization coverage. The slope index of inequality and the relative index of inequality were calculated. Results: Vaccination coverage against measles was inversely associated with unsatisfied basic needs in urban areas (P < 0.01) and the proportions of indigenous and African-Ecuadorian residents in the canton (P = 0.015), and directly associated with unemployment rate in the canton (P = 0.037). The distribution of immunization coverage across the cantons was heterogeneous, indicating spatial dependence. The non-immunization rate was 71% higher in the poorer cantons than in the upper stratum cantons (prevalence ratio 1.71; 95%CI: 1.69–1.72). A difference of 10.6 percentage points was detected in immunization coverage between cantons with the best vs. worst socioeconomic level, according to the slope index of inequality. The relative index of inequality revealed that immunization coverage was 1.12 times higher in cantons with the highest socioeconomic level vs. cantons with the lowest socioeconomic level. Conclusions: The spatial dependence between measles vaccination coverage and socioeconomic disparities suggests clusters of vulnerable populations for outbreaks. Health and social inequalities must be considered to achieve and maintain measles elimination.

KW - Epidemiological monitoring

KW - Health care disparities

KW - Measles-containing vaccine

KW - Socioeconomic factors

UR - https://www.scopus.com/pages/publications/85050467600

U2 - 10.1016/j.vaccine.2018.07.051

DO - 10.1016/j.vaccine.2018.07.051

M3 - Article

C2 - 30061028

AN - SCOPUS:85050467600

SN - 0264-410X

VL - 36

SP - 5251

EP - 5257

JO - Vaccine

JF - Vaccine

IS - 35

ER -

Socioeconomic inequalities and measles immunization coverage in Ecuador: A spatial analysis

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Beca Capes PEC-PEG para estudios de Doctorado

Cite this

Socioeconomic inequalities and measles immunization coverage in Ecuador: A spatial analysis

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Prizes

Beca Capes PEC-PEG para estudios de Doctorado

Cite this