Even as overall childhood vaccine coverage stayed relatively high in the United States, this national study shows that where a child lives, their family’s resources, and access to care still shape who gets fully protected.
Study: Social Determinants of Childhood Vaccination Coverage in the United States Using National Immunization Survey Data From 2010 to 2023: Cross-Sectional Study. Image Credit: PeopleImages / Shutterstock
A recent study published in the journal JMIR Public Health Surveillance reveals that childhood vaccination coverage in the United States (US) continues to be shaped by socioeconomic and structural inequalities. Analyzing data from the 2010–2023 National Immunization Survey-Child (NIS-Child), researchers at Indiana University, USA, identified consistent gaps associated with maternal education, household income, insurance status, language, and region.
Despite generally high coverage of core vaccines, disparities persist, underscoring the need for equity-focused public health strategies to improve access and protect all children from vaccine-preventable diseases. These findings highlight renewed concerns about the resurgence of vaccine-preventable diseases and the urgency of closing immunization gaps.
Vaccination programs have markedly reduced childhood morbidity and mortality, yet gaps in coverage persist in the United States. Even modest disparities can translate into meaningful population-level risks, as uneven vaccine uptake often clusters within specific communities, increasing the likelihood of localized outbreaks. These patterns show that national averages can mask critical gaps in immunization coverage.
Previous research has linked childhood vaccination to social determinants such as income, education, and access to care. However, most studies used pooled datasets, short time frames, or focused on individual vaccines, limiting insight into disparities across time and vaccine types. As a result, it remains unclear whether these inequities reflect persistent underlying structural factors or temporary disruptions. Examining vaccination uptake across sociodemographic groups can clarify these trends and support more targeted, equity-focused immunization strategies.
National Immunization Survey
In the present cross-sectional analysis, researchers analyzed the 2010-2023 NIS-Child survey data to examine early childhood vaccination uptake. The study included children aged 19-35 months with provider-verified immunization records, obtained through telephone-based household screening, parental consent, and follow-up requests to vaccination providers.
The primary outcome was up-to-date vaccination status for individual vaccines, based on age-appropriate dose thresholds, along with completion of the combined seven-vaccine series [DTaP, polio, measles–mumps–rubella, Haemophilus influenzae type b (Hib), hepatitis B, varicella, and pneumococcal conjugate vaccine (PCV)]. Additional vaccines, including influenza, rotavirus, and hepatitis A, were assessed separately.
The team applied survey-weighted logistic regression, using complete-case analysis, to estimate odds ratios (ORs) for the association between vaccination status and sociodemographic factors. These included child age, maternal education, birth order, household income-to-poverty ratio (IPR), insurance, interview language, and region.
The investigators fit separate models for each year to assess temporal stability, pandemic-related shifts, and vaccine-specific variation. Sensitivity analyses evaluated the robustness of the findings under alternative specifications regarding participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Vaccination Disparities Across Sociodemographic Groups
Vaccination coverage among US children showed modest gains over time, but underlying disparities remained striking. Using NIS-Child data, researchers found that the combined seven-vaccine series completion rates increased from about 71% at the start of the study period to nearly 77% by 2023, even as provider-verified response rates declined. Older children were consistently more likely to be fully vaccinated (OR, 1.1 in 2010; 1.2 in 2023), while larger household size remained a persistent barrier (OR, 0.9), suggesting logistical and access challenges in larger families.
Sociodemographic gradients showed persistent variation across years, with some factors becoming stronger predictors in later years. Insurance coverage and maternal education emerged as stronger predictors in recent years. Insured children had higher vaccination rates in 2022 (OR = 0.7 for uninsured). Language and regional disparities also persisted, with English-language interview households showing higher coverage in some years, while the Northeast generally recorded higher average vaccine counts than other regions. Hispanic origin was intermittently associated with lower uptake for selected vaccines, underscoring structural inequities.
Vaccine-specific patterns revealed uneven progress. Influenza coverage improved from 66% in 2010 to 78% in 2022 before plateauing, while hepatitis A uptake remained comparatively low. Although core vaccines such as polio and measles-mumps-rubella maintained coverage above 90%, rotavirus and influenza showed declines in 2022–2023. Notably, younger children aged 19–23 months lagged behind older cohorts, with this gap widening after the coronavirus disease 2019 (COVID-19) pandemic, suggesting disruptions to routine immunization schedules.
Together, these findings indicate that while overall coverage remains relatively high, gains have not been equitable. Stable associations with age and household size, alongside persistent disparities linked to education, insurance, and language, highlight enduring structural barriers that continue to shape vaccination uptake. Because the study was cross-sectional, these findings show associations rather than causation.
Equity-Focused Vaccination Policy Implications
The findings underscore that closing vaccination gaps in the United States will require policies that move beyond universal access toward equity-driven delivery. Expanding insurance coverage, strengthening Medicaid, and investing in community-based and culturally tailored outreach can help address persistent barriers linked to income, education, language, and geography. Improving provider-patient communication and access in underserved regions should remain a priority, particularly for larger households and marginalized groups.
Looking ahead, policymakers and researchers must integrate social determinants into immunization planning and evaluation. Longitudinal and state-level analyses, alongside qualitative research, can clarify underlying mechanisms and help identify high-risk subgroups. By aligning vaccination strategies with broader social and structural realities, future efforts can more effectively reduce disparities and sustain protection against vaccine-preventable diseases.
The authors also note that restricting the analysis to provider-verified records may introduce selection bias and that estimates from the post-2020 period should be interpreted with caution because provider participation and response patterns changed during and after the pandemic.
Journal reference:
Majji, R.K., Zhuang, Y., Pabon-Rodriguez, F.M. (2026). Social Determinants of Childhood Vaccination Coverage in the United States Using National Immunization Survey Data From 2010 to 2023: Cross-Sectional Study. JMIR Public Health Surveillance, 12, e81746. DOI: 10.2196/81746, https://publichealth.jmir.org/2026/1/e81746