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Individually Significant Risk Factors Do Not Provide an Accurate Clinical Prediction Rule for Infant Underimmunization in One Disadvantaged Urban Area

  • Simon J. Hambidge
    Correspondence
    Address correspondence to Simon J. Hambidge, MD, PhD, Mailcode 0132, Denver Health Medical Center, 777 Bannock St, Denver, CO 80204
    Affiliations
    Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Denver Community Health Services, Denver Health, Denver, Colo
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  • Stephanie L. Phibbs
    Affiliations
    Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colo
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  • Arthur J. Davidson
    Affiliations
    Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Family Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Denver Community Health Services, Denver Health, Denver, Colo
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  • Charles W. LeBaron
    Affiliations
    National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga
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  • Vijayalaxmi Chandramouli
    Affiliations
    Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Family Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Denver Community Health Services, Denver Health, Denver, Colo

    National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga
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  • Diane L. Fairclough
    Affiliations
    Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colo
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  • John F. Steiner
    Affiliations
    Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, Colo

    Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colo
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      Objective

      To define a clinical prediction rule for underimmunization in children of low socioeconomic status.

      Methods

      We assessed a cohort of 1160 infants born from July 1998 through June 1999 at an urban safety net hospital that received primary care at 4 community health centers. The main outcome measure was up-to-date status with the 3:2:2:2 infant vaccine series at 12 months of age.

      Results

      Latino infants (n = 959, 83% of cohort) had immunization rates of 74%, at least 18% higher than any other racial/ethnic group. Multivariate logistic regression demonstrated the following independent associations (relative risk, 95% confidence interval) for inadequate immunization: non-Latino ethnicity (1.7, 1.4–2.0), maternal smoking (1.3, 1.1–1.7), no health insurance (1.9, 1.4–2.3), late prenatal care (1.9, 1.5–2.3), no pediatric chronic condition (2.1, 1.2–3.1), and no intent to breast-feed (1.3, 1.1–1.6). However, the index of concordance (c-index) for this model was only 0.69. Neither excluding infants who left the health care system nor accounting for infants who were “late starters” for their first vaccines improved the predictive accuracy of the model.

      Conclusions

      In this predominantly Latino population of low socioeconomic status, Latino infants have higher immunization rates than other infants. However, we were unable to develop a model to reliably predict which infants in this population were underimmunized. Models to predict underimmunization should be tested in other settings. In this population, interventions to improve immunization rates must be targeted at all children without respect to individual risk factors.

      Key words

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