Ethnicity and immunization coverage among schools in Israel.
OBJECTIVE
Recent years have seen a global trend of declining immunization rates of recommended vaccines that is more pronounced among school-age children. Ethnic disparities in child immunization rates have been reported in several countries. We investigated an effect of ethnicity on the vaccination rates of immunizations routinely administered within schools in Israel.


DESIGN
Data were collected from the Ministry of Health database regarding immunization coverage for all registered Israeli schools (3736) in the years 2009-2011. Negative binomial regression was used to assess the association between school ethnicity and immunization coverage while controlling for school characteristics.


RESULTS
The lowest immunization coverage was found in Bedouin schools (median values of 75.1%, 81.5% and 0% for the first, second and eighth grades, respectively) in 2011. During this year, vaccination coverage in the first and second grades in Jewish schools was 1.51 and 1.35 times higher, respectively, compared to Bedouin schools. In the years 2009 and 2010, no significant increase in risk for lower vaccination rate was observed in Bedouin schools, and children in Arab and Druze schools were more likely to have been vaccinated.


CONCLUSION
The lower vaccination refusal rate found in Bedouin schools supports the hypothesis that difficulties related to accessibility constitute the main problem rather than noncompliance with the recommended vaccination protocol for school-age children, featuring higher socio-economic status groups. Our study emphasizes the importance of identifying, beyond the national-level data, subpopulation groups at risk for non-vaccination. This knowledge is essential to administrative-level policy-makers for the allocation of resources and the planning of intervention programs.
['Yitshak-Sade|Maayan|M|', 'Davidovitch|Nadav|N|', 'Novack|Lena|L|', 'Grotto|Itamar|I|']
D018912:Arabs D002648:Child D003140:Communicable Disease Control D016208:Databases, Factual D005006:Ethnicity D005260:Female D006297:Health Services Accessibility D006801:Humans D007557:Israel D007585:Jews D008297:Male D010342:Patient Acceptance of Health Care D012044:Regression Analysis D012572:School Health Services D012574:Schools D012959:Socioeconomic Factors D000073887:Vaccination Coverage
ethnicity immunization disparities Accessibility school health