GEORGIA IMMUNIZATION STUDY 2012 Final Report Georgia Department of Public Health Immunization Program | Acute Disease Epidemiology Unit Eighteen Public Health Districts Prepared by Rebecca M. Willis, MHS, Principal Investigator Manoj T. Rema, MPH, Author Jessica Tuttle, MD, Author and Primary Editor Cherie Drenzek, MS, DVM, Editor Steven Mitchell, MPH, Editor 1 2 Acknowledgements The Georgia Department of Public Health, Epidemiology and Immunization Programs, would like to thank the public health representatives that participated in this study for all of their hard work, support and dedication. This study could not have been completed successfully without the cooperation of Health District staff throughout Georgia. A profound thank you and sincere appreciation is also given to the private and non-public health providers and the Vaccines for Children providers that participated in this collaborative effort. Their cooperation and assistance throughout the study is greatly appreciated. Additional gratitude goes to Mike Chaney from the Georgia Chapter of the American Academy of Pediatrics for his support on making this study more pertinent to pediatricians throughout Georgia. 1 2 Executive Summary The 2012 Georgia Immunization Study (GIS) was conducted by the Georgia Department of Public Health Epidemiology Program, Georgia Immunization Program and Public Health Districts. However, this study could not have been conducted without the assistance of the private providers, public health providers and Vaccines for Children providers of Georgia that contributed to this collaborative effort. Their cooperation and assistance throughout the study was greatly appreciated. The two-year old GIS employs a retrospective cohort research design to determine the up-to-date immunization rate for children born in the state of Georgia. Immunization history data for 18 Health District cohorts of children who turned two in January of 2012, were analyzed to calculate these rates. Identifying information was obtained from electronic birth records, and immunization history data were collected primarily via the Georgia Registry of Immunization Transactions and Services (GRITS). Immunization rates for the 4:3:1:3:3:1:4 series (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV) were based on the childhood immunization and catch-up schedules recommended by the Advisory Committee on Immunization Practices (ACIP) in 20121. Each child's immunization record was reviewed in GRITS for completeness. If the child's record was not upto-date, an effort was made by local public health staff to contact parents and providers to obtain any missing immunization history data. If further follow-up revealed that the child was truly not up-to-date, the data collection process served as a reminder-recall system. If all of the 4:3:1:3:3:1:4 series dates occurred before the child reached 24 months, the child was classified as up-to-date by 24 months. Children were excluded from the up-to-date by 24 months classification if some of the 4:3:1:3:3:1:4 dates occurred after the child reached 24 months of age. Due to the reminder-recall effect of the data collection process, readers are strongly encouraged to use the up-to-date by 24 months measures for reporting purposes, since these were the rates prior to any parent or provider contact. In 2012, the Georgia statewide up-to-date immunization rate by 24 months was 84.5%, up from 82.4% in 2011 (Page 18, Table 2). Efforts to bring children up-to-date were evident in an overall 10.8% increase in immunization rate between 24 months of age and the end of the data collection period (Page xxvi, Appendix Table E-1). This increase is evidence that the children who are not up-to-date by 24 months can be brought up-to-date within six months if adequate patient recall and educational measures are taken. Although the majority of immunizations from our sample were administered in the private sector, the increase in up-to-date immunization rates by the end of the data collection is a testament to how instrumental District- and County-level public health staff can be in raising childhood immunization rates for a selected group of children. In addition, this increase shows that parents want their children to stay current on their vaccinations, but may benefit from reminders and follow-up from their providers. Although acute infection with Hepatitis B causes severe disease in only a small proportion of those infected, the greater burden of disease lies in those cases progressing to chronic infection, cirrhosis, and liver cancer later in life. Therefore, timely immunization practices with hepatitis B vaccine are a high priority for the Georgia Immunization Program, as well as for providers and hospitals throughout the state. Among the 2012 study sample of children who were born in Georgia in 2010, 82.7% received their first dose of hepatitis B vaccine at birth (Page xxvii, Appendix Table E-2), down from 83.4% in 2011 (children born in 2009) but up from 76.2% in 2010 (children born in 2008). In addition, the percentage of children who received the entire 3-dose hepatitis B series by 24 months of age slightly decreased from 96.5% in 2011 to 96.1% in 2012. These data suggest that the best way to protect children from hepatitis B infection by 24 months of age is to vaccinate at birth. Credit goes to birthing hospitals, obstetricians, pediatricians and public health staff who have been dedicated to this cause. 1 Department of Health and Human Services Centers for Disease Control and Prevention. (February 10, 2012). MMWR weekly: Recommended Immunization Schedules for Persons Aged 0 Through 18 Years --- United States, 2012. MMWR 2012; 61(5). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6105a5.htm 3 There was considerable variation by District in the percent of 24 month old children found to be fully immunized by 24 months, ranging from 77.3% in the Fulton District (3-2) to 92.9% in the Rome District (1-1). Between 2011 and 2012, District up-to-date by 24 months immunization rates rose by 2.5% overall for the state, with the greatest increase of 16.2% seen in the Columbus District (7-0) (Page xxvi, Appendix Table E -1). Although the percentage of Georgia children who received the fourth dose of DTaP by 24 months of age increased in 2012, it continues to significantly lag behind the percentage of children who received the third dose by 24 months of age. In fact, 97.0% of children had received 3 doses of DTaP by 24 months of age while only 87.0% had received their fourth dose in 2012 (Page 18, Table 2). The third dose can be given as early as 6 months of age; however the fourth dose must be delayed until at least 12 months and 6 months after the third dose. These results suggest that patient recall efforts specific for the fourth dose of DTaP may be helpful for children after their one year check-up. Future studies will assess the role of Medicaid and what role loss of coverage may contribute to the drop in fourth dose DTaP coverage. Some variation remained by District in the percent of two-year-olds reported to be fully immunized by the end of the data collection period, ranging from 84.0% in the Fulton District (3-2) to 98.7% in the Columbus District (7-0). These data support that contact with parents and providers during data collection made a difference. The greatest impact was seen in the Dublin District (5-1), where up-to-date immunization rates rose 20.0% by the end of the data collection period. Individual Health District results revealed some common demographic themes when identifying "high risk" groups, i.e. those less often up-to-date by 24 months. The groups that were high risk in at least seven Districts included children of unmarried mothers, children of mothers with previous children, and children of mothers less than 25 years of age. The groups that were high risk in at least nine Districts included children receiving immunizations from two providers instead of only one, children whose birth was covered by government-assisted insurance and children of mothers without a college education. Future study years will reveal which of these associations is consistent from year to year. Please see Section III (Page 25) for individual Health District results. A notable finding of the 2012 GIS is that no significant differences were noted in up-to-date immunization rates in any of the WIC populations. For example, there were no Districts in the state where children enrolled in WIC were significantly more likely to be up-to-date on their immunizations by 24 months (Page 24). However, in the South Central (Dublin) District (5-1), children enrolled in WIC were significantly less likely to be up-to-date on their immunizations by 24 months. Districts and healthcare providers are encouraged to review these WIC enrollment data (Page 24, Table 8) to determine the possible reasons for these trends, and share them with the Immunization Program as efforts continue to improve immunization rates in Georgia. Perhaps one of the most important parts of the 2012 report is the list of the top 3 Health Districts for various categories, including response rates, series immunization rates, and antigen-specific immunization rates (Page 23, Table 7). These rankings highlight our Immunization Champions; Districts challenged by a specific measure are encouraged to reach out to these champions to identify strategies for success. The 2012 GIS report offers the people of Georgia and its Public Health Districts a chance to study demographic and immunization history data simultaneously, so that evidence-based programs can be created to raise immunization rates across the state of Georgia. The 2012 data clearly show that although the vast majority of immunizations are administered outside of public health clinics, public health staff can effectively collaborate with parents and private sector providers, and have an impact on improving coverage rates. 4 Abbreviations & Vaccine Names Abbreviations 2YO ACIP CDC GIS GRITS NIS UTD WIC Vaccine Names DTaP IPV MMR HepB Hib Varicella PCV Rotavirus Influenza HepA Definitions Two year old Advisory Committee on Immunization Practices Centers for Disease Control and Prevention Georgia Immunization Study Georgia Registry of Immunization Transactions and Services National Immunization Survey (CDC) Up-to-date [immunization history] Women, Infants, and Children Program Diphtheria, Tetanus, and acellular Pertussis [vaccine] Inactivated Polio Virus [vaccine] Measles, Mumps, Rubella [vaccine] Hepatitis B [vaccine] Haemophilus influenza type b [vaccine] Varicella (chicken pox) [vaccine] Pneumococcal Conjugate Vaccine Rotavirus [vaccine] Seasonal Influenza [vaccine] Hepatitis A [vaccine] 5 6 Table of Contents Contents Acknowledgements Executive Summary Abbreviations Table of Contents Section I: Project Overview Methods (Sampling, Data Collection, Data Analysis) Limitations Section II: Statewide Results State of Georgia Immunization Report Contributing Staff from Georgia Division of Public Health State Sampling Scheme, Immunization Summary, Immunization Rates (2000-2012) State Sample Population Demographics, Findings and Comparisons Up-to-date (UTD) Immunization Rates by Demographic Group Antigen-Specific UTD Immunization Rates (2006-2012) District Immunization Rates Immunization Success Measures by Health District Findings Related to WIC Enrollment Section III: Health District Immunization Reports District 1-1 Immunization Report (Rome District) District 1-2 Immunization Report (Dalton District) District 2-0 Immunization Report (Gainesville District) District 3-1 Immunization Report (Cobb-Douglas District) District 3-2 Immunization Report (Fulton District) District 3-3 Immunization Report (Clayton District) District 3-4 Immunization Report (Gwinnett, Newton, Rockdale District) District 3-5 Immunization Report (DeKalb District) District 4-0 Immunization Report (LaGrange District) District 5-1 Immunization Report (Dublin District) District 5-2 Immunization Report (Macon District) District 6-0 Immunization Report (Augusta District) District 7-0 Immunization Report (Columbus District) District 8-1 Immunization Report (Valdosta District) District 8-2 Immunization Report (Albany District) District 9-1 Immunization Report (Savannah District) District 9-2 Immunization Report (Waycross District) District 10-0 Immunization Report (Athens District) 7 Page(s) 1 3--4 5 7--8 9--14 11--13 13--14 15--24 17-24 17 18 19 20 21 22 23 24 25--134 27--30 31--34 35--38 39--42 43--46 47--50 51--54 55--58 59--62 63--66 67--70 71--74 75--78 79--82 83--86 87--90 91--94 95--98 Table of Contents Contents Appendix Appendix A: Margins of Error for UTD Immunization Rates Appendix B: Sources and Characteristics of Demographic Variables Appendix C: Reasons for Incomplete Immunization History Appendix D: Sample Population Demographics, by District Appendix E: District Immunization Measures Page(s) i-xiii iii-iv v--vi vii ix--xxvi xxvii--xxviii 8 Section I Project Overview Georgia Immunization Study, 2012 9 10 Methods Study Design The annual Georgia Immunization Study (GIS) employs a retrospective cohort research design to ascertain the up-to-date (UTD) immunization rate for two-year-old children born in the state of Georgia. Immunization history data for cohorts of children who turned two in January, 2012 from 18 Health Districts were analyzed to calculate these rates. Identifying information was obtained from electronic birth records, and immunization history data were collected primarily via the Georgia Registry of Immunization Transactions and Services (GRITS). Immunization rates for the 4:3:1:3:3:1:4 vaccine series (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV vaccine doses) were based on the childhood immunization and catch-up schedules recommended by the Advisory Committee on Immunization Practices (ACIP) in 2012. At the end of the six-month data collection period, each immunization date was compared to the child's birth date to determine whether it was administered before or after 24 months of age. If all of the 4:3:1:3:3:1:4 series administration dates occurred before the child reached 24 months of age, then the child was classified as UTD by 24 months. Children were excluded from the UTD by 24 months classification if some of the 4:3:1:3:3:1:4 administration dates occurred after the child reached 24 months of age. A distinction was made between "UTD by 24 months" and "UTD by end of data collection" because the data collection process, which involved contact with each child's parent and healthcare provider, indirectly served as a reminderrecall system. Many of the parents of study participants were simply unaware that their child was not current on their immunizations; therefore, the difference between the percentage of children UTD by 24 months and children UTD by end of data collection may be a proxy measure of the impact of parent and provider contact in raising immunization rates. Children who were classified as UTD by 24 months were also included in the UTD by end of data collection group. UTD immunization rates (both UTD by 24 months and UTD by end of data collection) were calculated for the state sample and the District samples, as well as for demographic groups within these samples. Target and Sample Populations The target population of the 2012 GIS included all 24month-old children born in the state of Georgia in 2010. A sample of 2,589 children born in the month of January 2010 was selected for the study. The sample design allowed for independent estimates for each of the 18 Health Districts in the state. The final sample estimate for the state was based on weighted data to account for differential probabilities of selection for each Health District and selected from the total number of statewide births during the month of January 2010. The number of children randomly selected from each District depended on population distribution statistics, response rates and District immunization rates from the 2011 GIS. Information for each child, including all available birth certificate variables, was collected. Examples of the type of birth certificate information obtained for each child included: Child's first, middle, and last name Child's sex Child's date of birth Child's gestational age Mother's residential and mailing address(es) Mother's residential county Mother's first, middle, and last name Father's first, middle, and last name (if available) Mother's race and ethnicity 11 Methods Section, p2 Mother's level of education Mother's marital status Mother's age Payment type used to cover child's birth Other demographic variables used in the analysis, such as Provider Type and Number of Providers, were obtained during the data collection period. The WIC enrollment variable was collected for each child by matching the names and dates of birth for all of the sample children with WIC enrollment data. If a child was found to be enrolled in WIC for any amount of time during their first 24 months of life, they were designated as "enrolled in WIC". The provider-related variables were compiled using GRITS data. When the data were originally collected at the State Epi office, the number of providers was recorded. Each child was classified as having 1, 2, or 3+ providers. The "Provider Type" variable was determined based on the location where each individual vaccine was administered (see Part III: Immunization History, below). If a child received vaccines exclusively in private provider offices, the child was classified as "Private Sector Only". If a child received vaccines exclusively in public health clinics, the child was classified as "Public Sector Only". If a child received vaccines in both private provider offices and public health clinics, the child was classified as "Both". American Academy of Family Physicians (AAFP). The TWOY data collection system contains five distinct sections to be completed by the public health data collectors: Child, Notes, Guardians, Providers, and VX List (Immunization History). Data collection was carried out primarily by County and District Public Health Nurses. Data collectors in each Health District participated in training via conference call at the start of the data collection period. A Training Manual was also provided and made available on the TWOY log-in screen. Data Collection Protocol Step #1: Search for immunization records at State and local health departments. Before the data collection process began at the Health District level, the Principal Investigator at the State Epi office queried GRITS records and loaded the immunization history of each child into the TWOY system. If a child was up-to-date (UTD) at this point, the child was listed as "Complete, Based on Initial GRITS Record", and no longer required follow-up. If a child was not UTD at this point, the data collection process was passed to the District staff, with the dates found in GRITS already entered into the TWOY system. Next, data collectors reviewed GRITS records or health department records for additional immunization history. If the child's immunization record was still incomplete, the data collectors proceeded to Steps 2 and 3 below. Data Collection An electronic web-based data collection system named "TWOY" was used to systematically collect the required information for each child. The TWOY system follows the recommended schedule of childhood immunizations jointly approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the Step #2: Search for immunization records through the parent(s) and/or guardian(s). In this step, data collectors used the contact information from the birth certificate or any updated contact information found at the health department or in GRITS to contact the child's parent. Data collectors also used sources such as city phone directories, directory assistance, and the internet to find current 12 Methods Section, p3 contact information for parents. Parents were then contacted by phone and/or letter and asked to provide an immunization history or the location of immunization information for their child (i.e., the name of the doctor or clinic office). Data collectors also sent consent forms to parents. In some cases, representatives made home visits to collect data. using each individual vaccine date for each child. An immunization was classified as given prior to the 24 months birthday if the difference between the dose date and the child's DOB was equal to or less than 24 months; this was the case even for dates that were not originally found in the child's GRITS record. For a child to be considered UTD by 24 months, all of the doses in the 4:3:1:3:3:1:4 series had to be given within 24 months of the child's birth date. Step #3: Search for immunization records through private physician(s). In this step, data collectors contacted private physicians by phone or fax and requested the child's immunization history. Most physicians preferred to respond by updating the child's immunization history in GRITS. In some cases, providers preferred to communicate by phone, fax, or office visit. To account for possible scheduling delays by physician office staff, a 2-week grace period was applied to the 24-month calculations. Limitations The following describe important limitations of the study that should be considered when interpreting study results: Step #4: Data returned to State Epi office and checked for accuracy. Using the TWOY system, data collectors completed follow-up on all children by the end of the six-month data collection period, and all completed records were reviewed by the Principal Investigator throughout the process. Attempts were made to resolve any unclear information before data cleaning using Stata/SE 10. 1. There were three limitations related to sampling: Although the study included a random sample of children born in January 2010 and, thus, represented a fair estimate of immunization rates for all two-year-olds born in 2010, it could not account for variations that may routinely occur in other months of the year. Data Analysis The 2012 data analysis methods were the same as those employed in 2011. Analyses were done using Stata/SE 10 software and macros developed by the Principal Investigator. Demographic variables were used to determine which demographic groups are more or less often UTD by 24 months. UTD immunization rates for demographic groups were assessed at both the state and District levels. Up-to-date (UTD) immunization rates were calculated Second, limiting the sample to children born in one month does not form the basis of a surveillance system capable of detecting changes in the health care system. Third, there may be children in the eligible sample who were erroneously included in the eligible sample and listed as unable-to-locate. Examples of this type of error would be cases where a child died, was adopted, or was part of a military family, but the child's ineligibility related to these circumstances never became known to the public health data collectors because the child could not 13 Methods Section, p4 be found. 2. Response rates for each District are included on the first and second pages of all District reports. Response rate is calculated by subtracting the number of "Unable to Locate" children by the number of eligible participants and then dividing by the number of eligible participants. Caution should be taken when interpreting immunization rates for a District with a low response rate. The reason for this necessary caution is that the children who are unable-to-locate could also be the least UTD. However, we cannot use their immunization history without knowing that it is current, so they must be excluded. Table A shows how the response rate was calculated for the state sample; this same method was used for each of the Health District samples. For future studies, the possibility of combining the two Hispanic fields will be considered. Table 1: Sampling Scheme, GIS Georgia, 2012 2012 (n) Original Sample 2,973 Ineligible 130 Eligible Sample 2,835 Refused to Participate 8 Unable to Locate 246 Final Sample 2,589 Response Rate (%) 92.3 Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. 3. Maternal race/ethnicity was used as a demographic variable in the analysis. The categories included in analysis were: White, non-Hispanic (n=1058) White, Hispanic (n=112) Black (n=958) Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41) Some race/ethnicity demographics were not used in analyses due to an insufficient number of cases. In addition, Hispanic ethnicity was divided between two race categories, "white, Hispanic" and "unspecified, Hispanic" because the majority of Hispanics were found in the "white" race and "unspecified" race. This issue occurs at the electronic birth record level, where the people collecting birth data may not understand the necessity of entering a race and ethnicity. For this to change, training will have to take place at birthing hospitals throughout the state. 14 Section II Statewide Results Georgia Immunization Study, 2012 15 16 State of Georgia 2012 Georgia Immunization Study Report Rebecca M. Willis, MHS Manoj T. Rema, MPH Jessica Tuttle, MD State-Level Immunization Study Staff Immunization Study Epidemiologist, Primary Author Immunization Study Epidemiologist, Author Medical Epidemiologist, Author & Primary Editor 1-2 1-1 2-0 10 4-0 6-0 5-2 7-0 8-2 5-1 9-1 9-2 8-1 Metro Atlanta Districts 3-1 3-4 3-2 3-5 3-3 17 State of Georgia 2012 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: The UTD immunization rate by 24 months of age for the state sample was 84.5%, which increased to 93.6% by the end of the six-month data collection period (Table 2). From 2011 to 2012: Up-to-date (UTD) coverage by 24 months increased by 2.5% from 2011 to 2012. UTD coverage rates by the end of data collection were comparable between 2011 and 2012 (Figure 1). Sample population demographics for Georgia and their effect on immunization rates are discussed on the following pages. Table 2: Immunization Summary by Series and Vaccine Antigen, Georgia, 2012 2011 2012 (%) (%) UTD immunization rate* by 24 months UTD immunization rate* by end of six-month data collection 4 DTaP by 24 months 3 DTaP by 24 months 82.4 84.5 94.0 93.6 85.8 87.0 97.5 97.0 Table 1: Sampling Scheme, Georgia, 2012 2011 (n) 2012 (n) Original Sample 2,447 2,973 Ineligible 82 130 Eligible Sample 2,359 2,835 Refused to Participate Unable to Locate 6 8 210 246 Final Sample 2,150 2,589 Response Rate (%) 91.4 92.3 Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. 3 IPV by 24 months 96.7 96.0 1 MMR by 24 months 93.0 93.2 UTD Hib by 24 months 3 Hep B by 24 months 95.1 96.1 96.5 96.1 1 Varicella by 24 months 93.9 94.2 UTD PCV by 24 months 96.7 92.2 2 Rotavirus by 24 months 83.8 70.6 2 Hep A by 24 months 53.1 57.3 1+ Influenza by 24 months 60.1 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 1: Georgia Immunization Study (GIS) and National Immunization Survey (NIS) Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 Georgia: UTD by 24 months NIS, GA: UTD at 19-35 months Georgia: UTD by end of data coll ection NIS, US: UTD at 19-35 months * 2009 data was not collected due to personnel vacancy. 18 Table 3: Sample Population Demographics, Georgia, 2012 Maternal Race/Ethnicity, White, nonHispanic (n=1,058) White, Hispanic (n=112) Black (n=958) State Sample of Jan. 2010 Births n=2,589 (%) All Georgia 2010 Births n= 133,668 (%) 40.9 42.7 4.3 4.2 37.0 33.0 Notable Demographic Findings: Overall, the study sample for the state was comparable to the 2010 Georgia birth cohort, but varied for certain demographic variables (Table 3). For example, the final state sample contained a much larger percentage of children residing in a metro area versus a non-metro area (76.1% vs. 53.9%) and a lower number of mothers over 35 years of age (11.6% vs. 35.7%) compared to the 2010 birth cohort. Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41) Maternal Education, Some College+ (n=1,076) HS Diploma/GED (n=779) 9th-11th grade (n=457) <9th grade (n=160) WIC Non-WIC (n=1423) WIC (n=1166) 8.8 9.5 The state sample also had a higher number of 2.2 3.3 children whose mothers were less than 25 years 1.6 3.2 of age compared to all Georgia 2010 births (41.3% vs. 37.0%). 41.6 46.8 Other demographic measures for the state 30.1 29.0 sample were similar to the findings of the 2010 Georgia birth cohort as a whole. 17.7 14.2 6.2 5.3 Some demographic variables were measured outside of the birth record and could not be measured for the entire 2010 Georgia birth 54.9 - cohort, namely WIC status, Number of Providers, and Provider Type. 45.1 - Metro Residence Metro (n=1,969) 76.1 53.9 Non-metro (n=617) Maternal Marital Status 23.8 46.1 Married (n=1,269) 49.0 54.5 Unmarried (n=1,314) 50.8 45.5 Repeat Birth First Child (n=1,102) Repeat Birth (n=1,484) Gestational Age 42.6 42.7 57.3 57.3 Child's Gender % of State % of Georgia Sample 2010 Births (n=2,589) (n=133,668) <37 weeks (n=296) 11.4 12.2 Male (n=1,303) 50.3 51.3 37+ weeks (n=2,293) Provider Type, 88.6 87.8 Female (n=1,286) 49.7 48.7 Number of Providers, Public Sector Only (n=52) 2.0 - 1 (n=1,326) 51.2 - Private Sector Only (n=1,728) 66.7 - 2 (n=444) 17.1 - Both (n=172) Payment at Birth 6.6 - 3 (n=182) Maternal Age 7.0 - Government Assist (n=1,304) 50.4 46.6 <25 years (n=1,068) 41.3 37.0 Private Insurance (n=711) 27.5 31.0 25-34 years (n=1,220) 47.1 27.3 Other (n=129) 5.0 5.7 35+ years (n=301) 11.6 35.7 Self Pay (n=141) 5.4 5.0 Please refer to Appendix B for detailed information about the collection of information for this variable. Indicates that the percentages for this variable may not add up to 100.0% because the information was missing in some cases. Indicates that this variable corresponds to the data collected at the time of delivery. 19 State of Georgia Immunization Study Report, p4 Table 4: UTD Immunization Rates by 24 months UTD Immunization Rates by Demographic Group: by demographic group, Georgia--2012 In Georgia, immunization rates by 24 months of age varied between certain demographic groups UTD by 24 UTD by end of (Table 4). months data collection (%) (%) In terms of maternal race/ethnicity, children of Asian, Hispanic, and multiracial mothers were the Georgia Sample (n=2,589) 84.5 93.6 most often UTD by 24 months. Maternal Race/Ethnicity, White, NonHispanic (n=1,058) White, Hispanic (n=112) Higher maternal education was positively associat- 85.0 92.3 ed with UTD by 24 months coverage rates above the high school level. 89.3 96.4 Black (n=958) Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41) 81.6 93.2 Children of mothers who had previous children were less often UTD by 24 months than children of 86.5 96.5 mothers without previous children. In addition, 94.6 96.4 children of married mothers were more often UTD 90.2 100.0 by 24 months than children of unmarried mothers. Maternal Education, Some College+ (n=1,076) HS Diploma/GED (n=779) Children whose birth was covered by private insur- ance were more often UTD by 24 months than chil- 86.6 94.1 dren whose birth was covered by government- 82.9 92.8 assisted insurance. 9th-11th grade (n=457) <9th grade (n=160) WIC 82.9 93.2 In terms of number of providers, children with 2 85.6 96.3 providers were less often UTD by 24 months than those with only one provider, or three providers. Non-WIC (n=1423) 89.4 94.2 WIC (n=1166) Maternal Age <25 years (n=1,068) 25-29 years (n=1,220) 87.0 83.6 84.8 93.5 94.3 UTD by 24 months (%) UTD by end of data collection (%) 92.7 Number of Providers, 30+ years (n=301) 86.7 94.4 Maternal Marital Status and Repeat Birth Combination 1 (n=1,326) 2 (n=444) 85.4 94.0 82.4 92.3 Married, First Birth (n=494) Unmarried, First Birth (n=607) 90.7 87.6 94.9 3 (n=182) 85.0 95.9 96.9 Child's Gender Married, Repeat Birth (n=775) Unmarried, Repeat Birth (n=707) Gestational Age 82.5 79.6 92.7 Male (n=1,303) 84.6 94.2 90.7 Female (n=1,286) 84.5 92.9 Metro Residence <37 weeks (n=296) 37+ weeks (n=2,293) Provider Type, 83.5 84.7 94.3 Metro (n=1,969) 83.9 93.0 93.5 Non-metro (n=617) 86.4 95.3 Footnotes Public Sector Only (n=52) Private Sector Only (n=1,728) Both (n=172) Payment at Birth, Government Assist (n=1,304) Private Insurance (n=711) Other (n=129) Self Pay (n=141) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 92.3 "d.c." is an abbreviation for "data collection" 93.8 Indicates that this variable corresponds to the data 94.8 collected at the time of delivery. Indicates that the sample size numbers for this variable 92.9 may not add up to the total District sample size because the information was missing in some cases. 94.8 96.1 Please see Appendix C for additional information regarding the methodology in obtaining this variable. 95.7 20 State of Georgia Immunization Study Report, p5 To varying degrees, demographic-related disparities between the study sample and the Georgia birth cohort resolved by the end of data collection (Table 4, column in italics). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p.13), the statewide results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age and may be reasonable recipients for targeted educational and outreach efforts: Children of less educated mothers Children of mothers with previous children Children of unmarried mothers Children receiving immunizations from two or more providers or lacking a medical home Please refer to Section III for Health District specific rates and trends. Table 5: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, Georgia, 2006-2012 2006 2007 2008 2010 2011 2012 4 DTaP by 24 months 76.1 76.4 76.5 84.5 85.8 87.0 3 Polio by 24 months 87.8 87.8 87.5 95.1 96.7 96.0 1 MMR by 24 months 86.1 91.4 92.7 91.5 93.0 93.2 UTD Hib by 24 months 87.5 91.1 86.1 90.0 95.1 96.1 3 Hepatitis B by 24 months 88.4 88.8 88.7 94.8 96.5 96.1 1 Varicella by 24 months 86.5 85.2 85.5 92.9 93.9 94.2 UTD PCV by 24 months 73.6 77.2 81.6 90.5 96.7 92.2 2 Rotavirus* - 1 Influenza*, by 24 months - - - 72.6 83.8 70.6 - - 58.2 60.1 57.1 2 Hepatitis A* by 24 months - - - -- 53.1 55.1 Hepatitis B birth dose* 54.8 58.3 66.2 76.2 83.4 82.7 * This vaccine is not included in the 4:3:1:3:3:1:4 vaccine series, which is the series routinely measured for this age group. The first year of receiving the influenza vaccine requires 2 doses to be protected for that year; measuring 1 dose is a way to measure general interest in receiving the influenza vaccine, not completion or protection against influenza illness. Immunization Rates by Vaccine Antigen: In Georgia, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2006 to 2008, but increased to higher rates than ever in 2010 and remained high through 2012 (Table 5). Among Georgia coverage rates by antigen in 2012, the DTaP UTD immunization rate was lowest at 87.0%, similar to 85.8% in 2011. The PCV UTD immunization rate was the second-lowest at 92.2%, down from 96.7% in 2011. Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased in Georgia from 43.4% in 2005 (not shown) to 92.2% in 2012. Antigen-Specific Conclusions: Because of the lower coverage rates for DTaP and PCV vaccineshe antigenspecific data suggest that these vaccines could reasonably be the primary focus of District- and County-level immunization campaigns. 21 State of Georgia Immunization Study Report, p6 District Immunization Rates: While the statewide UTD immunization coverage rate by 24 months was 84.5%, variation was seen between Districts. The Districts with the highest UTD immunization rates by 24 months were Districts 1-1, 1-2, 4-0, 7-0 and 8-1. The Districts with the lowest UTD immunization rates by 24 months were Districts 3-2, 3-4, 5-1, 6-0, and 9-1 (Figure 3 and Table 6). Response rates for each District are included on the second page of all District reports (Section III) and caution should be taken when interpreting immunization rates for a District with a low response rate. The reason for this necessary caution is that the children who were classified as unable-to-locate could also be the least UTD. However, we cannot use their immunization history without knowing that it is current, so they must be excluded. Figure 3: UTD by 24 months Immunization Rates by District, Georgia, 2012 1-2 1-1 2-0 10 >87.3% 82.5%-87.3% <82.5% 6-0 4-0 5-2 7-0 5-1 9-1 8-2 8-1 9-2 Table 6: District UTD Immunization Rates by 24 months and by End of Data Collection, Georgia, 2012 District UTD by 24 months (%) UTD by end of data collection (%) Final Sample Size (n) 1-1 Northwest (Rome) 92.9 96.9 127 1-2 North Georgia (Dalton) 87.4 95.1 143 2-0 North (Gainesville) 84.1 94.4 126 3-1 Cobb-Douglas 82.9 95.0 140 3-2 Fulton 77.3 84.0 194 3-3 Clayton 83.9 95.2 124 3-4 Gwinnett, Newton, Rockdale 81.5 91.8 195 3-5 DeKalb 87.3 98.0 150 4-0 LaGrange 88.1 96.7 151 5-1 South Central (Dublin) 77.9 93.5 77 5-2 North Central (Macon) 85.4 93.7 158 6-0 East Central (Augusta) 82.4 93.7 159 7-0 West Central (Columbus) 91.0 98.7 156 8-1 South (Valdosta) 88.9 96.3 81 8-2 Southwest (Albany) 83.3 88.6 132 9-1 Coastal (Savannah) 80.7 93.4 181 9-2 Southeast (Waycross) 84.4 93.8 128 10-0 Northeast (Athens) Georgia 85.0 84.5 90.4 93.5 167 2,589 Color Shading Legend : <82.5% : 82.5%-87.3% : >87.3% 22 State of Georgia Immunization Study Report, p7 Immunization Success Measures by Health District: Data analyses for this study were done on the statelevel, allowing for uniform data analysis covering all of the 18 Health Districts in Georgia. However, there are key measures that can be very telling of a Health District's success in keeping their children up-to-date on all of their immunizations by 24 months of age. Please refer to Table 7 for a list of these success measures and the first-, second-, and third-placing Health Districts as applicable to each measure. The top portion of the table addresses the Districts who had the highest immunization coverage rates and response rates as well as one-year increases. Some of these measures represent an average over a five-year span and some are only relative to 2012 results. The lower portion of the Table addresses the vaccine antigen-specific coverage by 24 months and only includes 2012 results. Congratulations to all of the Districts Immunization Champions; those ranking in the top three for any of the categories! Table 7: District Immunization Champions, Georgia, 2007-2012 Category 1st Place 2nd Place 3rd Place Highest Response Rate, 2012 Gaines. District (2-0) 100.0% Augusta District (6-0) 99.4% Athens District (10-0) 98.2% Highest UTD by 24 months in 2012 Rome District (1-1) 92.9% Columbus District (7-0) Valdosta District (8-1) 91.0% 88.9% Highest UTD by end of data collection, 2012 Columbus District (7-0) DeKalb District (3-5) 98.7% 98.0% Rome District (1-1) 96.9% Highest 5-year Average: Response Rate (2007-2012) Augusta District (6-0) 99.9% Gaines. District (2-0) 98.0% Dalton District (1-2) 97.7% Highest 5-year Average: UTD by 24 months (2007-2012) Gainesville Dist. (2-0) 84.7% Augusta District (6-0) 83.8% Rome District (1-1) 82.0% Greatest Increase in UTD by 24 months from 2011 to 2012 Columbus District (7-0) 12.7% Dalton District (1-2) 9.1% LaGrange District (4-0) 6.8% Greatest Increase in UTD by end of data collection from 2011 to 2012 Columbus District (7-0) LaGrange District (4-0) 9.1% 7.2% Dalton District (1-2) 3.8% Greatest Increase in UTD from 24 months to end of data collection, 2012 Dublin District (5-1) 15.6% Savannah District (9-1) 12.7% Cobb District (3-1) 12.1% Highest Coverage*: 4+ DTaP Doses, 2012 Rome District (1-1) 95.3% Columbus District (7-0) 93.6% Dalton District (1-2) 90.2% Highest Coverage*: 3+ Polio Doses, 2012 Valdosta District (8-1) Columbus District (7-0) Savannah District (9-1) 98.8% 98.7% 98.3% Highest Coverage*: 1 MMR Dose, 2012 Rome District (1-1) 96.9% Columbus District (7-0) LaGrange District (4-0) 96.8% 96.7% Highest Coverage*: UTD Hib, 2012 Columbus District (7-0) LaGrange District (4-0) 98.7% 98.7% Rome District (1-1) 98.4% Highest Coverage**: Hepatitis B Birth Dose, 2012 Columbus District (7-0) 94.2% Valdosta District (8-1) 91.4% Macon District (5-2) 90.5% Highest Coverage*: 3+ Hepatitis B Doses, 2012 Columbus District (7-0) Savannah District (9-1) Valdosta District (8-1) 99.4% 98.9% 98.8% Highest Coverage*: 1 Varicella Dose, 2012 LaGrange District (4-0) 98.7% Rome District (1-1) 98.4% Dalton District (1-2) 97.9% Highest Coverage*: UTD PCV, 2012 Valdosta District (8-1) 98.8% Athens District (10-0) 97.0% Rome District (1-1) 96.9% Highest Coverage*: 1+ Hepatitis A Doses, 2012 Albany District (8-2) 64.4% Valdosta District (8-1) Columbus District (7-0) 64.2% 63.5% Highest Coverage*: 1+ Influenza Doses, 2012 Dalton District (1-2) Gainesville District (2-0) Rome District (1-1) 71.3% 69.1% 64.6% *Highest immunization coverage by 24 months of age. **Highest percentage of children who received the first dose of Hepatitis B within their first 3 days of life. 23 State 92.3% 84.5% 93.6% 92.8% 77.7% 2.1% -0.4% 9.1% 87.0% 96.0% 93.2% 96.1% 82.7% 96.1% 94.2% 92.2% 57.3% 57.1% State of Georgia Immunization Study Report, p8 Findings Related to WIC Enrollment: Statewide results do not show an overall disparity in UTD immunization rate by 24 months between WIC-enrolled children and children not enrolled in WIC (see Table 4). This appears to be consistent with District-level analyses. In general, Health District does not appear to modify the effect of WIC on UTD immunization status by 24 months of age. District 5-1 was the only District where the children enrolled in WIC had a significant difference (lower) in immunization rate than those not enrolled in WIC. The other seventeen Districts did not show any significant difference between WIC groups (Figure 4 and Table 8). As can be seen in Section III, each District has distinct population demographics. Immunization campaigns that work for one District may not work for another, but disparities, like this one related to WIC enrollment, can lead to opportunities for idea-sharing between Districts and between programs. Figure 4: Immunization Rates among WIC and Non-WIC Enrolled Children, Georgia, 2012 1-2 1-1 2-0 10 4-0 6-0 5-2 7-0 5-1 9-1 9-2 8-2 8-1 No Difference WIC enrolled lower Table 8: Difference in UTD Immunization Rate by 24 months between WIC Enrollment Groups, Georgia, 2012 District Immunization Rate for children enrolled in WIC (%) Immunization Rate for children not enrolled in WIC (%) Disparity (WIC Rate-Non-WIC Rate) (%) 95% Confidence Interval of Difference (% -- %)* 1-1 Northwest (Rome) 93.2 94.1 -0.9 -9.4 -- 7.6 1-2 North Georgia (Dalton) 90.4 87.9 2.5 -7.9 -- 12.9 2-0 North (Gainesville) 87.7 84.1 3.6 -8.5 -- 15.7 3-1 Cobb-Douglas 90.0 87.8 2.2 -8.5 -- 12.9 3-2 Fulton 77.3 75.6 1.7 -10.5 -- 13.9 3-3 Clayton 90.2 90.5 -0.3 -10.7 -- 10.1 3-4 Gwinnett, Newton, Rockdale 84.5 90.1 -5.6 -15.1 -- 3.9 3-5 DeKalb 98.5 96.5 2.0 -2.9 -- 6.9 4-0 LaGrange 94.7 94.7 0.0 -7.4 -- 7.4 5-1 South Central (Dublin) 76.3 97.4 -21.1 -35.5 -- -6.7 5-2 North Central (Macon) 86.3 94.1 -7.8 -17.1 -- 1.5 6-0 East Central (Augusta) 80.7 88.2 -7.5 -18.7 -- 3.7 7-0 West Central (Columbus) 91.0 95.5 -4.5 -12.2 -- 3.2 8-1 South (Valdosta) 86.0 94.7 -8.7 -21.3 -- 3.9 8-2 Southwest (Albany) 83.6 87.7 -4.1 -16.0 -- 7.8 9-1 Coastal (Savannah) 85.5 85.7 -0.2 -10.5 -- 10.1 9-2 Southeast (Waycross) 86.4 85.5 0.9 -11.2 -- 13.0 10-0 Northeast (Athens) 85.9 91.3 -5.4 -15.5 -- 4.7 Georgia 87.0 89.4 -2.4 -4.9 -- 0.1 *If the confidence interval overlaps zero, then the difference between groups is not statistically significant. 24 Section III Health District Immunization Reports Georgia Immunization Study, 2012 25 26 District 1-1 2012 Georgia Immunization Study Report District 1-1 Data Collection Team Janet Eberhart, RN, BSN District Immunization Coordinator Dade Catoosa County Sample Metro Bartow 20 Metro Catoosa 2 Metro Chattooga 4 Nonnetro Dade 1 Metro Floyd 26 Metro Gordon 15 Nonmetro Haralson 14 Metro Paulding 29 Metro Polk 9 Nonmetro Walker 7 Metro District 1-1 127 District UTD by 24 months 92.9% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate 27 Walker Chattooga Gordon Floyd Bartow Polk Haralson Paulding District 1-1 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 1-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (92.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (96.9% vs. 93.6%) (Table 1-1-B). From 2011 to 2012: The District 1-1 UTD immunization rate by 24 months increased by 5.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 1.2% from 2011 to 2012 (Figure 1-1-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 1-1-A: GIS Sampling Scheme, District 1-1, 2012 District 1-1 State (n) (n) Original Sample 150 2,973 Ineligible 4 130 Refused to Participate 1 8 Eligible Sample Unable to Locate 145 2,835 18 246 Final Sample 127 2,589 Response Rate (%) 87.6% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 1-1-B: Immunization Summary by Series & Vaccine Antigen, District 1-1, 2012 District State 1-1 Average (%) (%) UTD immunization rate* by 24 months UTD immunization rate* by end of data collection 4 DTaP by 24 months 3 DTaP by 24 months 3 IPV by 24 months 1 MMR by 24 months 92.9 84.5 96.9 93.6 95.3 87.0 98.4 97.0 97.6 96.0 96.9 93.2 UTD Hib by 24 months 98.4 96.1 3 Hep B by 24 months 97.6 96.1 1 Varicella by 24 months 98.4 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 96.9 92.2 78.7 70.6 63.0 57.3 64.6 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 1-1-C: Georgia Immunization Study and District 1-1 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 1-1: UTD by 24 months District 1-1: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 28 District 1-1, Georgia Immunization Study Report, p3 Table 1-1-F: UTD Immunization Rates by Demographic group, District 1-1, 2012 State Avg. 1-1--UTD UTD by 24 by 24 months months (%) (%) 1-1--UTD by end of d.c. (%) District 1-1 Sample (n=127) Maternal Race/Ethnicity, 84.5 92.9 96.9 White, NonHispanic (n=90) 85.0 92.2 96.7 White, Hispanic (n=5) Black (n=12) 89.3 81.6 100.0 91.7 100.0 91.7 Unspecified, Hispanic (n=2) 86.5 100.0 100.0 Asian (n=0) 94.6 - - Multiracial (n=2) Maternal Education, 90.2 100.0 100.0 Some College+ (n=53) 86.6 96.2 96.2 HS Diploma/GED (n=41) 82.9 85.4 95.1 9th-11th grade (n=23) 82.9 100.0 100.0 <9th grade (n=9) 85.6 88.9 100.0 WIC Non-WIC (n=68) 89.4 94.1 97.1 UTD Immunization Rates by Demographic Group: In District 1-1, the UTD immunization rates among white, non-Hispanics was higher than the state's UTD by 24 months rate (92.2% vs. 85.0%), however the District's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 1-1-F). For District 1-1, children of mothers with a high school diploma/GED and no college education were least often UTD by 24 months (85.4%). In terms of maternal age, children of mothers 35+ years of age were least often UTD by 24 months of age (90.9%). In terms of the maternal marital status and repeat births, children of unmarried mothers with previous children were most often UTD by 24 months (100.0%), and this was markedly different from the overall state finding (79.6%). In addition, the District data support the importance of a medical home; children who had one provider (Number of Providers) were more often UTD than those with two providers (96.3% vs. 92.9%). Although many demographic-related disparities resolved by the end of data collection, some still remained and some new disparities emerged (Table 1 -1-F, column in italics). For example, children of WIC (n=59) Maternal Age <25 years (n=63) 25-34 years (n=53) 87.0 83.6 84.8 93.2 92.1 94.3 96.6 State Avg. 1-1--UTD 1-1--UTD UTD by 24 by 24 by end of months months d.c. 98.4 (%) (%) (%) 96.2 Number of Providers, 35+ years (n=11) 86.7 90.9 Maternal Marital Status & Repeat Birth Combination 90.9 1 (n=81) 2 (n=28) 85.4 82.4 96.3 92.9 98.8 100.0 Married, First Birth (n=38) Unmarried, First Birth (n=27) 90.7 97.4 97.4 3+ (n=6) 85.0 83.3 83.3 87.6 88.9 100.0 Child's Gender Married, Repeat Birth (n=44) 82.5 88.6 93.2 Male (n=60) 84.6 95.0 98.3 Unmarried, Repeat Birth (n=18) Gestational Age 79.6 100.0 100.0 Female (n=67) 84.5 91.0 95.5 Metro Residence <37 weeks (n=23) 83.5 91.3 95.7 Metro (n=99) 83.9 92.9 96.0 37+ weeks (n=104) Provider Type, 84.7 93.3 97.1 Non-metro (n=28) 86.4 92.9 Footnotes 100.0 Public Sector Only (n=1) Private Sector Only (n=107) Both (n=9) Payment at Birth, Government Assist (n=53) Private Insurance (n=46) Other (n=12) Self Pay (n=5) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 100.0 94.4 100.0 88.7 95.7 100.0 100.0 100.0 98.1 100.0 96.2 95.7 100.0 100.0 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic group. 29 District 1-1, Georgia Immunization Study Report, p4 mothers with a high school diploma or college education were slightly less likely to be UTD by the end of data collection, but these groups were larger than those of lesser educated mothers (96.2% and 95.1% vs. 100.0%). In addition, the District data support the importance of a medical home; children who had one or two providers (Number of Providers) remained more often UTD by the end of the data collection, than those with 3+ providers (98.8% and 100.0% vs. 83.3%). Children of mothers 35+ years of age Firstborn children of unmarried mothers and children of married mothers with previous children Children receiving immunizations from more than two providers Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 1-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of mothers with a high school diploma/GED level of education Table 1-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-1, 2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 76.1 89.0 89.6 86.5 90.8 80.4 80.4 - 2007 79.1 93.4 89.6 88.5 94.0 89.0 81.9 - Immunization Rates by Vaccine Antigen: In District 1-1, the UTD immunization rate by 24 months for most vaccine antigens increased to higher rates than ever in 2012 (Table 1-1-G). Among District 1-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP showed the most improvement over 2011, rising from 88.3% to 95.3%. The UTD immunization rates for MMR and Varicella showed the second highest improvements at 96.9% and 98.4%, up from 92.6% and 92.6%, respectively, in 2011. 2008 74.1 90.7 86.4 84.6 93.2 86.4 82.1 - 2010 88.6 98.6 95.0 92.9 96.4 95.7 95.0 67.9 61.4 2011 88.3 96.8 92.6 95.7 96.8 92.6 95.7 87.2 70.2 2012 95.3 97.6 96.9 98.4 97.6 98.4 96.9 78.7 64.6 Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.4% in 2005 (not shown) to 96.9% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, MMR, and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns, though levels are over 95% for all antigen-specific immunizations. 30 District 1-2 2012 Georgia Immunization Study Report District 1-2 Data Collection Team Marie Smith, RN District Immunization Coordinator Angie Callaway, RN Secondary Data Collector Patricia Mason LPN Secondary Data Collector Nancy Stackhouse, LPN Secondary Data Collector County Sample Metro Cherokee 69 Metro Fannin 5 Nonmetro Gilmer 11 Nonmetro Murray 14 Metro Pickens 9 Metro Whitfield 35 Metro District 1-2 143 District UTD by 24 months 87.4% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Murray Whitfield Fannin Gilmer Pickens Cherokee 31 District 1-2 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 1-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (87.4% vs. 84.5%), and remained higher at the end of data collection (95.1 vs. 93.6%) (Table 12-B). From 2011 to 2012: The District 1-2 UTD immunization rate by 24 months increased by 11.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 4.2% from 2011 to 2012 (Figure 1-2-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 1-2-A: GIS Sampling Scheme, District 1-2, 2012 District 1-2 (n) State (n) Original Sample 159 2,973 Ineligible 9 130 Refused to Participate 1 8 Eligible Sample Unable to Locate 149 2,835 6 246 Final Sample 143 2,589 Response Rate (%) 96.0% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 1-2-B: Immunization Summary by Series & Vaccine Antigen, District 1-2, 2012 District State 1-2 Average (%) (%) UTD immunization rate* by 24 months 87.4 84.5 UTD immunization rate* by end of data collection 95.1 93.6 4 DTaP by 24 months 90.2 87.0 3 DTaP by 24 months 97.9 97.0 3 IPV by 24 months 97.9 96.0 1 MMR by 24 months 95.8 93.2 UTD Hib by 24 months 97.9 96.1 3 Hep B by 24 months 98.6 96.1 1 Varicella by 24 months 97.9 94.2 UTD PCV by 24 months 93.0 92.2 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 69.9 70.6 59.4 57.3 71.3 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 1-2-C: Georgia Immunization Study and District 1-2 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 1-2: UTD by 24 months Georgia: UTD by 24 months District 1-2: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 32 District 1-2, Georgia Immunization Study Report, p3 Table 1-2-F: UTD Immunization Rates by Demographic group, District 1-2, 2012 State Avg. UTD by 24 months (%) 1-2--UTD by 24 months (%) 1-2--UTD by end of d.c. (%) UTD Immunization Rates by Demographic Group: In District 1-2, children of Hispanic mothers of unspecified race were UTD by 24 months at a similar rate as children of white, non-Hispanic mothers (88.5% vs. 88.1%). The District's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 1-2-F). District 1-2 Sample (n=143) Maternal Race/Ethnicity, White, NonHispanic (n=93) White, Hispanic (n=2) 84.5 87.4 95.1 Children of mothers 25-34 years of age were least often UTD by 24 months of age (86.8%). In terms of 85.0 88.1 93.6 maternal marital status and repeat births, children of married mothers with previous children were 89.3 50.0 100.0 least often UTD by 24 months (78.0%). Black (n=5) Unspecified, Hispanic (n=26) Asian (n=2) Multiracial (n=0) 81.6 86.5 94.6 90.2 60.0 88.5 100.0 NA 80.0 100.0 100.0 NA Children born at a gestational age of 37+ weeks were more often UTD by 24 months than those born at a gestational age less than 37 weeks (88.1 vs. 77.8%). Maternal Education, Some College+ (n=49) Most children had only one provider, and were more often UTD by 24 months of age than children 86.6 87.8 93.9 with 2 providers (89.2% vs. 76.7%). HS Diploma/GED (n=38) 9th-11th grade (n=25) <9th grade (n=19) WIC Non-WIC (n=91) 82.9 92.1 94.7 Although many demographic-related disparities 82.9 84.0 96.0 resolved by the end of data collection, some still 85.6 89.5 100.0 remained and some new ones emerged (Table 1-2- F, column in italics). For example, children of Hispanic mothers remained more often UTD at the 89.4 87.9 94.5 end of data collection when compared to children WIC (n=52) Maternal Age <25 years (n=55) 25-34 years (n=68) 87.0 83.6 84.8 90.4 87.3 86.8 98.1 State Avg. 1-2--UTD 1-2--UTD UTD by 24 by 24 by end of months months d.c. 98.2 (%) (%) (%) 92.7 Number of Providers 35+ years (n=20) 86.7 90.0 Maternal Marital Status & Repeat Birth Combination 95.0 1 (n=83) 2 (n=30) 85.4 89.2 96.4 82.4 76.7 86.7 Married, First Birth (n=39) Unmarried, First Birth (n=23) 90.7 87.6 94.9 95.7 97.4 100.0 3+ (n=12) Child's Gender 85.0 100.0 100.0 Married, Repeat Birth (n=50) Unmarried, Repeat Birth (n=28) Gestational Age 82.5 78.0 88.0 Male (n=77) 84.6 85.7 92.2 79.6 85.7 100.0 Female (n=66) 84.5 89.4 98.5 Metro Residence <37 weeks (n=9) 83.5 77.8 100.0 Metro (n=121) 83.9 86.8 95.0 37+ weeks (n=134) Provider Type 84.7 88.1 94.8 Non-metro (n=20) 86.4 90.0 95.0 Footnotes Public Sector Only (n=3) Private Sector Only (n=118) Both (n=12) Payment at Birth, Government Assist (n=50) Private Insurance (n=48) Other (n=8) Self Pay (n=16) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 100.0 89.0 66.7 100.0 94.9 91.7 88.0 83.3 87.5 87.5 94.0 93.8 100.0 100.0 33 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 1-2, Georgia Immunization Study Report, p4 of non-Hispanic mothers, the next largest group (100% vs. 93.6%). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 1-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of white, non-Hispanic mothers Children of mothers 25-34 years of age Children of married mothers with previous children Children who were born at a gestational age of less than 37 weeks Children whose residence is in a metropolitan county Table 1-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-2, 2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 94.6 100.0 94.6 94.6 97.3 94.6 89.2 - 2007 86.4 93.2 93.2 97.7 97.8 95.5 88.6 - Immunization Rates by Vaccine Antigen: In District 1-2, the UTD immunization rates by 24 months for most vaccine antigens rose between 2006 and 2012. A notable increase occurred for the UTD 4 DTaP measure, rising from 81.7% in 2011 to 90.2% in 2012 (Table 1-2-G). Among District 1-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for PCV showed no change at 93.0%. The UTD immunization rate for Rotavirus was the only antigen-specific 2008 75.9 91.4 86.2 89.7 91.4 87.9 86.2 - 2010 86.8 96.5 91.2 85.1 96.5 94.7 93.9 77.2 60.5 2011 81.7 93.9 90.4 91.3 95.7 93.0 93.0 82.6 60.0 2012 90.2 97.9 95.8 97.9 98.6 97.9 93.0 69.9 71.3 immunization rate to actually decrease between 2011 and 2012. Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 57.5% in 2005 (not shown) to 93.0% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 34 District 2-0 2012 Georgia Immunization Study Report District 2-0 Data Collection Team Constance Martin RN BSN District Immunization Coordinator Sandy T. Moore Primary Data Collector County Sample Metro Banks 1 Nonmetro Dawson 2 Metro Forsyth 33 Metro Franklin 6 Nonmetro Habersham 17 Nonmetro Hall 46 Metro Hart 2 Nonmetro Lumpkin 4 Nonmetro Rabun 2 Nonmetro Stephens 5 Nonmetro Towns 0 Nonmetro Union 3 Nonmetro White 5 Nonmetro District 2-0 126 District UTD by 24 months 84.1% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Union Towns Rabun Lumpkin White Habersham Stephens Dawson Hall Forsyth Banks Franklin Hart 35 District 2-0 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 2-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (84.1% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (94.4% vs. 93.6%) (Table 2-0-B). From 2011 to 2012: The District 2-0 UTD immunization rate by 24 months decreased by 3.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 0.8% from 2011 to 2012 (Figure 2-0-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 2-0-A: GIS Sampling Scheme, District 2-0, 2012 District 2-0 (n) State (n) Original Sample 138 2,973 Ineligible 12 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 126 2,835 0 246 Final Sample 126 2,589 Response Rate (%) 100.0% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 2-0-B: Immunization Summary by Series & Vaccine Antigen, District 2-0, 2012 District State 2-0 Average (%) (%) UTD immunization rate* by 24 months 84.1 84.5 UTD immunization rate* by end of data collection 94.4 93.6 4 DTaP by 24 months 3 DTaP by 24 months 86.5 87.0 97.6 97.0 3 IPV by 24 months 96.8 96.0 1 MMR by 24 months 96.0 93.2 UTD Hib by 24 months 3 Hep B by 24 months 96.8 96.1 93.5 96.1 1 Varicella by 24 months 95.2 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 90.5 92.2 89.7 70.6 51.6 57.3 69.1 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 2-0-C: Georgia Immunization Study and District 2-0 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 2-0: UTD by 24 months Georgia: UTD by 24 months District 2-0: UTD by end of data collection Georgia: UTD by end of data colle ction * 2009 data was not collected due to personnel vacancy. 36 District 2-0, Georgia Immunization Study Report, p3 Table 2-0-F: UTD Immunization Rates by Demographic group, District 2-0, 2012 State Avg. UTD by 24 months (%) 2-0--UTD by 24 months (%) 2-0--UTD by end of d.c. (%) District 2-0 Sample (n=126) 84.5 84.1 94.4 UTD Immunization Rates by Demographic Group: In District 2-0, children of white, non-Hispanic mothers were least likely to be UTD by 24 months compared to the District sample as a whole (77.3% vs. 84.1%) and this discrepancy remained at the end of data collection (90.7% vs. 94.4%) although other race/ethnicity groups were small (Table 2-0-F). Maternal Race/Ethnicity, White, NonHispanic (n=75) White, Hispanic (n=21) Children of mothers with some college education were more often UTD at 24 months compared to 85.0 77.3 90.7 children of mothers who had only completed high 89.3 95.2 100.0 school (84.8% vs. 75.6%). Black (n=5) Unspecified, Hispanic (n=7) Asian (n=6) Multiracial (n=0) Maternal Education, Some College+ (n=46) HS Diploma/GED (n=41) 81.6 100.0 100.0 In terms of maternal age, children of mothers 35+ 86.5 85.7 100.0 years of age were least often UTD by 24 months of 94.6 100.0 100.0 age (77.8%) and children of mothers 25-34 years of age were most often UTD by 24 months (89.7%). 90.2 - - In terms of maternal marital status and repeat births, children of unmarried mothers who were 86.6 84.8 93.5 firstborn were least often UTD at the end of data 82.9 75.6 92.7 collection (86.4%) (see Table 2-0-F). 9th-11th grade (n=25) <9th grade (n=9) WIC Non-WIC (n=69) 82.9 92.0 96.0 The District 2-0 data support the importance of a 85.6 88.9 100.0 medical home; children who had one provider (Number of Providers) were more often UTD by 24 months than those with two providers (85.2% 89.4 84.1 92.8 vs. 70.0%). WIC (n=57) 87.0 87.7 Maternal Age <25 years (n=50) 83.6 80.0 25-34 years (n=58) 84.8 89.7 35+ years (n=18) 86.7 77.8 Maternal Marital Status, & Repeat Birth Combination Married, First Birth (n=34) 90.7 94.1 Unmarried, First Birth (n=22) 87.6 77.3 Married, Repeat Birth (n=48) 82.5 77.1 Unmarried, Repeat Birth (n=22) Gestational Age 79.6 90.9 <37 weeks (n=15) 83.5 93.3 37+ weeks (n=111) Provider Type 84.7 82.9 Public Sector Only (n=3) 73.1 100.0 Private Sector Only (n=67) 86.0 83.6 Both (n=3) Payment at Birth, 73.8 100.0 Government Assist (n=60) Private Insurance (n=39) 82.1 88.2 81.7 87.2 Other (n=12) 89.2 83.3 Self Pay (n=2) 87.2 100.0 96.5 94.0 94.8 94.4 97.1 86.4 93.8 100.0 100.0 93.7 100.0 95.5 100.0 95.0 94.9 91.7 100.0 37 State Avg. UTD by 24 months (%) 2-0--UTD by 24 months (%) Number of Providers 1 (n=54) 85.4 85.2 2 (n=10) 82.4 70.0 2-0--UTD by end of d.c. (%) 96.3 90.0 3 (n=7) Child's Gender Male (n=74) Female (n=52) Metro Residence 85.0 84.6 84.5 100.0 78.4 92.3 100.0 90.5 100.0 Metro (n=84) 83.9 83.3 94.1 Non-metro (n=42) 86.4 85.7 95.2 Footnotes "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 2-0, Georgia Immunization Study Report, p4 Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 2-0-F, column in italics). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 2-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of white, non-Hispanic mothers Children of mothers who completed a high school education Children of unmarried mothers without previous children and married mothers with previous children Children receiving immunizations from two different providers Table 2-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 2-0, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 85.2 3 Polio by 24 months 92.6 1 MMR by 24 months 85.2 UTD Hib by 24 months 96.3 3 Hepatitis B by 24 months 96.3 1 Varicella by 24 months 88.9 UTD PCV by 24 months 77.8 2 Rotavirus - 1 Influenza by 24 months - 89.3 88.0 86.9 90.3 94.1 92.0 95.2 97.9 94.1 94.0 92.9 94.5 94.1 88.0 91.7 97.2 96.4 92.0 96.4 97.9 95.2 94.0 91.7 95.2 88.1 90.0 90.5 97.2 - - 79.8 92.4 - - 65.5 66.2 2012 86.5 96.8 96.0 96.8 93.7 95.2 90.5 89.7 69.1 Immunization Rates by Vaccine Antigen: In District 2-0, the UTD immunization rates for most vaccine antigens fluctuated from 2006 to 2012, and most decreased between 2011 and 2012. Only MMR coverage rates increased from 2011 to 2012 (Table 20-G). Among District 2-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 86.5%, down from 90.3% in 2011. The UTD immunization rate for PCV was the secondlowest at 90.5%, down from 97.2% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine should be the primary focus of District and County-level immunization campaigns. 38 District 3-1 2012 Georgia Immunization Study Report District 3-1 Data Collection Team Karen Thomas, RN District Immunization Coordinator Silvia Frausto Data Collector County Sample Metro Cobb Douglas District 3-1 District UTD by 24 months Immunization Rate State of Georgia State UTD by 24 months Immunization Rate 118 22 140 82.9% 2,589 84.5% Metro Metro Cobb Douglas 39 District 3-1 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 3-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (82.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (95.0% vs. 93.6%) (Table 3-1B). From 2011 to 2012: The District 3-1 UTD immunization rate by 24 months decreased by 3.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 0.7% from 2011 to 2012 (Figure 3-1-C). Sample population demographics for this District and their effect on UTD immunization rates are discussed on the following pages. Table 3-1-A: GIS Sampling Scheme, District 3-1, 2012 District 3-1 (n) State (n) Original Sample 171 2,973 Ineligible 14 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 157 2,835 17 246 Final Sample 140 2,589 Response Rate (%) 89.8% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 3-1-B: Immunization Summary by Series & Vaccine Antigen, District 3-1, 2012 District State 3-1 Average (%) (%) UTD immunization rate* by 24 months 82.9 84.5 UTD immunization rate* by end of data collection 95.0 93.6 4 DTaP by 24 months 3 DTaP by 24 months 85.7 87.0 95.7 97.0 3 IPV by 24 months 94.3 96.0 1 MMR by 24 months 90.7 93.2 UTD Hib by 24 months 3 Hep B by 24 months 93.6 96.1 95.0 96.1 1 Varicella by 24 months 91.4 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 92.1 92.2 75.7 70.6 52.9 57.3 60.0 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 3-1-C: Georgia Immunization Study and District 3-1 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 3-1: UTD by 24 months Georgia: UTD by 24 months District 3-1: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 40 District 3-1, Georgia Immunization Study Report, p3 Table 3-1-F: UTD Immunization Rates by Demographic group, District 3-1, 2012 State Avg. UTD by 24 months (%) 3-1--UTD by 24 months % 3-1--UTD by end of d.c. (%) District 3-1 Sample (n=140) 84.5 82.9 95.0 Maternal Race/Ethnicity, White, NonHispanic (n=58) 85.0 79.3 93.1 UTD Immunization Rates by Demographic Group: In District 3-1, children of white, non-Hispanic mothers, the largest demographic group in this District sample, were less often UTD by 24 months compared to the District sample as a whole (79.3% vs. 82.9%). Children of Black mothers were UTD by 24 months at a rate consistent with the District sample (81.8% vs. 82.9%). The District's other race/ ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-1-F). White, Hispanic (n=14) Black (n=44) Unspecified, Hispanic (n=8) 89.3 85.7 100.0 In terms of maternal education, children of mothers with a high school diploma were less often UTD by 81.6 81.8 95.5 24 months compared to children of mothers with 86.5 100.0 100.0 some college education (69.4% vs. 85.9%). Asian (n=3) Multiracial (n=4) Maternal Education, Some College+ (n=78) HS Diploma/GED (n=36) 94.6 100.0 100.0 With regard to maternal age, children of mothers 90.2 100.0 100.0 <25 years of age were least often UTD by 24 months of age (76.3%). With regard to maternal marital status and repeat births, children of unmarried 86.6 85.9 98.7 mothers with previous children were the least often 82.9 69.4 UTD by 24 months (73.1%). 86.1 9th-11th grade (n=17) <9th grade (n=5) WIC Non-WIC (n=90) 82.9 88.2 94.1 In terms of payment at birth, District 3-1 children whose birth costs were covered by private 85.6 100.0 100.0 insurance were more often UTD than children whose birth costs were covered by government- assisted insurance (91.8% vs. 76.9%). 89.4 87.8 94.4 WIC (n=50) Maternal Age <25 years (n=38) 25-34 years (n=76) 87.0 90.0 94.0 83.6 76.3 92.1 State Avg. UTD by 24 months (%) 3-1--UTD by 24 months (%) 3-1--UTD by end of d.c. (%) 84.8 86.8 96.1 Number of Providers 35+ years (n=26) 86.7 80.8 96.2 1 (n=) 85.4 - - Maternal Marital Status & Repeat Birth Combination 2 (n=) 82.4 - - Married, First Birth (n=34) 90.7 91.2 94.1 3+ (n=) 85.0 - - Unmarried, First Birth (n=25) 87.6 88.0 100.0 Child's Gender Married, Repeat Birth (n=55) 82.5 80.0 96.4 Male (n=78) 84.6 83.3 94.9 Unmarried, Repeat Birth (n=26) Gestational Age 79.6 73.1 88.5 Female (n=62) 84.5 82.3 95.2 Metro Residence <37 weeks (n=13) 83.5 84.6 100.0 Metro (n=140) 83.9 82.9 95.0 37+ weeks (n=127) Provider Type 84.7 82.7 94.5 Non-metro (n=0) 86.4 0 0 Footnotes Public Sector Only (n=) Private Sector Only (n=) Both (n=) Payment at Birth, Government Assist (n=65) Private Insurance (n=49) Other (n=8) Self Pay (n=4) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 - 76.9 91.8 75.0 75.0 - 92.3 100.0 100.0 100.0 41 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 3-1, Georgia Immunization Study Report, p4 Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-1-F, column in italics). Children whose mothers are <25 years of age Children whose birth was covered by governmentassisted insurance For example, children of white non-Hispanic mothers remained the least often UTD (93.1%). In addition, children of mothers with only a high school diploma remained less often UTD by the end of data collection compared to those whose mothers had a college level education (86.1% vs. 98.7%). Information on provider type and number of providers per child was not available. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 3-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of white, Hispanic mothers Children whose mothers have a high school graduate level of education Table 3-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-1, 2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 73.9 83.0 86.2 87.2 86.2 83.5 79.4 - 2007 80.1 90.3 87.2 86.7 90.3 84.1 83.2 - Immunization Rates by Vaccine Antigen: In District 3 -1, the UTD immunization rates by 24 months for most vaccine antigens fluctuated from 2006 to 2010, but all increased to higher rates in 2011, and then all decreased in 2012. (Table 3-1-G). Among District 3-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 85.7%, as it has been over the last 6 years. The UTD immunization rate for MMR was the second-lowest at 90.7%, though it remained higher than in 2008 when it was 88.0%. 2008 77.6 88.5 88.0 85.3 87.4 85.8 82.0 - 2010 88.8 94.0 94.0 90.3 94.0 93.3 91.0 79.9 61.9 2011 89.7 98.3 94.8 97.7 96.6 95.4 98.3 87.4 74.7 2012 85.7 94.3 90.7 93.6 95.0 91.4 92.1 75.7 60.0 Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 45.1% in 2005 (not shown) to 98.3% in 2011, then fell to 92.1% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 42 District 3-2 2012 Georgia Immunization Study Report District 3-2 Data Collection Team Georgia Goseer, RN District Immunization Coordinator County Sample Metro Fulton District 3-2 District UTD by 24 months Immunization Rate State of Georgia State UTD by 24 months Immunization Rate 194 194 77.3% 2,589 84.5% Metro Fulton 43 District 3-2 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 3-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (77.3% vs. 84.5%). At the end of data collection, the District UTD immunization rate remained lower than the state rate (84.0% vs. 93.6%) (Table 3-2-B). From 2011 to 2012: The District 3-2 UTD immunization rate by 24 months decreased by 5.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 11.0% from 2011 to 2012 (Figure 3-2-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 3-2-A: GIS Sampling Scheme, District 3-2, 2012 District 3-2 State (n) (n) Original Sample 225 2,973 Ineligible 4 130 Refused to Participate 1 8 Eligible Sample Unable to Locate 220 2,835 26 246 Final Sample 194 2,589 Response Rate (%) 89.1% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 3-2-B: Immunization Summary by Series & Vaccine Antigen, District 3-2, 2012 District State 3-2 Average (%) (%) UTD immunization rate* by 24 months 77.3 84.5 UTD immunization rate* by end of data collection 84.0 93.6 4 DTaP by 24 months 3 DTaP by 24 months 83.0 87.0 93.8 97.0 3 IPV by 24 months 91.2 96.0 1 MMR by 24 months 87.1 93.2 UTD Hib by 24 months 3 Hep B by 24 months 93.8 96.1 93.3 96.1 1 Varicella by 24 months 88.7 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 86.6 92.2 73.2 70.6 50.0 57.3 57.2 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% 90% 80% 70% 60% 50% 40% Figure 3-2-C: Georgia Immunization Study and District 3-2 Immunization Rates, 2000-2012 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 3-2: UTD by 24 months Georgia: UTD by 24 months District 3-2: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 44 District 3-2, Georgia Immunization Study Report, p3 Table 3-2-F: UTD Immunization Rates by Demographic group, District 3-2, 2012 State Avg. UTD by 24 months (%) 3-2--UTD by 24 months % 3-2--UTD by end of d.c. (%) District 3-2 Sample (n=194) Maternal Race/Ethnicity, 84.5 77.3 84.0 White, NonHispanic (n=53) 85.0 79.3 81.1 White, Hispanic (n=2) 89.3 100.0 100.0 Black (n=94) 81.6 71.3 83.0 UTD Immunization Rates by Demographic Group: In District 3-2, children of black mothers were less often UTD by 24 months when compared to the District sample as a whole (71.3% vs. 77.3%). Most of the District's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-2-F). In terms of maternal education, children of mothers who were still in high school were the least often UTD by 24 months (65.6%). In contrast, children of mothers with a high school or some college education were the most often UTD by 24 months (80.4% and 80.7%). Unspecified, Hispanic (n=31) Asian (n=6) 86.5 90.3 93.6 Children of mothers 35+ years of age were most 94.6 83.3 83.3 often up to date by 24 months of age (80.7%). Multiracial (n=4) Maternal Education, Some College+ (n=93) 90.2 100.0 100.0 In terms of maternal marital status and the repeat births, children of married mothers were the most 86.6 80.7 86.0 often UTD by 24 months (82.6% and 83.0%). HS Diploma/GED (n=46) 9th-11th grade (n=32) <9th grade (n=11) WIC Non-WIC (n=119) 82.9 80.4 91.3 Children whose birth costs were covered by private 82.9 65.6 71.9 insurance were more often UTD by 24 months than those whose birth costs were covered by 85.6 90.9 90.9 government-assisted insurance (82.7% vs. 68.4%). In addition, the District data support the 89.4 75.6 82.4 importance of a medical home; children who WIC (n=75) Maternal Age <25 years (n=66) 25-34 years (n=97) 87.0 83.6 84.8 77.3 72.7 79.4 88.0 State Avg. 3-2--UTD 3-2--UTD UTD by 24 by 24 by end of months months d.c. 80.3 (%) (%) (%) 85.6 Number of Providers 35+ years (n=31) 86.7 80.7 Maternal Marital Status & Repeat Birth Combination 87.1 1 (n=103) 2 (n=24) 85.4 74.8 82.5 82.4 66.7 70.8 Married, First Birth (n=46) Unmarried, First Birth (n=49) 90.7 87.6 82.6 75.5 87.0 3+ (n=8) 89.8 Child's Gender 85.0 100.0 100.0 Married, Repeat Birth (n=47) 82.5 83.0 87.2 Male (n=90) 84.6 77.8 85.6 Unmarried, Repeat Birth (n=52) Gestational Age 79.6 69.2 73.1 Female (n=104) 84.5 76.9 82.7 Metro Residence <37 weeks (n=17) 37+ weeks (n=177) Provider Type 83.5 76.5 82.4 Metro (n=194) 83.9 77.3 84.0 84.7 77.4 84.2 Non-metro (n=0) 86.4 - - Footnotes Public Sector Only (n=3) Private Sector Only (n=128) Both (n=4) Payment at Birth, Government Assist (n=79) Private Insurance (n=75) Other (n=12) Self Pay (n=9) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 66.7 74.2 100.0 68.4 82.7 83.3 88.9 100.0 80.5 100.0 79.8 88.0 83.3 88.9 45 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 3-2, Georgia Immunization Study Report, p4 received immunizations from only one provider (Number of Providers) were more often UTD than those receiving immunizations from two providers (74.8% vs. 66.7%). Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-2-F, column in italics). For example, children of mothers who were still in high school remained the least often UTD by the end of data collection (see Table 3-2-F). Similarly, children receiving immunizations from only one provider remained more often UTD by the end of data collection, compared to children receiving immunizations by two providers (82.5% vs. 70.8%). Children whose mothers are still in high school Children of unmarried mothers Children whose birth was covered by governmentassisted insurance Children receiving immunizations from more than one provider Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 3-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of black mothers Table 3-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-2, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 63.9 58.7 66.4 84.3 86.3 3 Polio by 24 months 79.4 72.2 79.9 94.0 96.3 1 MMR by 24 months 79.4 68.8 78.5 91.7 93.8 UTD Hib by 24 months 81.6 70.7 74.8 89.8 95.0 3 Hepatitis B by 24 months 76.5 71.3 78.5 94.0 96.3 1 Varicella by 24 months 79.8 68.1 78.1 93.1 91.9 UTD PCV by 24 months 70.8 61.8 70.8 89.8 96.9 2 Rotavirus - - - 72.7 86.9 1 Influenza by 24 months - - - 61.1 58.8 2012 83.0 91.2 87.1 93.8 93.3 88.7 86.6 73.2 57.2 Immunization Rates by Vaccine Antigen: In District 32, UTD immunization rates by 24 months consistently increased for most vaccine antigens occurring from 2006 to 2010, reaching an all-time high in 2011 in all but varicella and influenza vaccines. All antigenspecific rates dropped in 2012, most notably PCV (96.9% to 86.6%). (Table 3-2-G). Among District 3-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP by vaccine antigen was lowest at 83.0%, even lower than 84.3% in 2010. The PCV UTD immunization rate was second-lowest at 86.6%. Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.8% in 2005 (not shown) to 96.9% in 2011, but then decreased to 86.6% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that DTaP, MMR, varicella, and PCV vaccines could reasonably be the primary focus of District immunization campaigns. 46 District 3-3 2012 Georgia Immunization Study Report District 3-3 Data Collection Team Freda Sheppard, LPN District Immunization Coordinator County Sample Metro Clayton District 3-3 District UTD by 24 months Immunization Rate State of Georgia State UTD by 24 months Immunization Rate 124 124 83.9% 2,589 84.5% Metro Clayton 47 District 3-3 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 3-3 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (83.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (95.2% vs. 93.6%) (Table 3-3-B). From 2011 to 2012: The District 3-3 UTD immunization rate by 24 months decreased by 0.8% from 2011 to 2012. The District UTD immunization rate by the end of data collection remained unchanged between 2011 and 2012 (Figure 3-3-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 3-3-A: GIS Sampling Scheme, District 3-3, 2012 District 3-3 State (n) (n) Original Sample 139 2,973 Ineligible 3 130 Refused to Participate 1 8 Eligible Sample Unable to Locate 135 2,835 11 246 Final Sample 124 2,589 Response Rate (%) 91.9% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 3-3-B: Immunization Summary by Series & Vaccine Antigen, District 3-3, 2012 District State 3-3 Average (%) (%) UTD immunization rate* by 24 months 83.9 84.5 UTD immunization rate* by end of data collection 95.2 93.6 4 DTaP by 24 months 3 DTaP by 24 months 84.7 87.0 94.4 97.0 3 IPV by 24 months 95.2 96.0 1 MMR by 24 months 94.4 93.2 UTD Hib by 24 months 3 Hep B by 24 months 93.6 96.1 96.0 96.1 1 Varicella by 24 months 96.0 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 92.0 92.2 62.9 70.6 54.0 57.3 41.9 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 3-3-C: Georgia Immunization Study and District 3-3 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 40% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 3-3: UTD by 24 months Georgia: UTD by 24 months District 3-3: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 48 District 3-3, Georgia Immunization Study Report, p3 Table 3-3-F: UTD Immunization Rates by Demographic group, District 3-3, 2012 State Avg. UTD by 24 months (%) 3-3--UTD by 24 months % 3-3--UTD by end of d.c. (%) District 3-3 Sample (n=124) 84.5 83.9 95.2 UTD Immunization Rates by Demographic Group: In District 3-3, children of unspecified, Hispanic mothers were similarly UTD by 24 months when compared to the District sample as a whole (83.9%). Children of black mothers were more often UTD by 24 months (86.7%).The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-3-F). Maternal Race/Ethnicity, White, NonHispanic (n=4) White, Hispanic (n=2) Black (n=75) In terms of maternal education, children of mothers 85.0 50.0 75.0 with a college education were the least often UTD by 24 months (80.0%) of all of the maternal 89.3 50.0 50.0 education groups, although this difference resolved 81.6 86.7 96.0 by the end of data collection. Unspecified, Hispanic (n=31) Asian (n=4) Multiracial (n=2) Maternal Education, Some College+ (n=40) HS Diploma/GED (n=39) 9th-11th grade (n=23) <9th grade (n=14) WIC Non-WIC (n=63) 86.5 83.9 96.8 Children of mothers between the ages of 25 and 34 94.6 100.0 100.0 years were least likely to be UTD at 24 months 90.2 50.0 100.0 (76.1%) compared to this demographic group in the state as a whole (84.8%). 86.6 80.0 95.0 In terms of maternal marital status and repeat births, children of married mothers with previous 82.9 87.2 94.9 children were the least often UTD by 24 months 82.9 87.0 95.7 (76.7%) although this resolved by the end of data collection. 85.6 85.7 100.0 District 3-3 children whose birth costs were covered by private insurance were more often UTD by 24 90.5 90.5 96.8 months than children whose birth costs were WIC (n=61) Maternal Age <25 years (n=38) 25-34 years (n=67) 90.2 90.2 93.4 83.6 89.5 97.4 State Avg. UTD by 24 months (%) 3-3--UTD by 24 months (%) 3-3--UTD by end of d.c. (%) 84.8 76.1 92.5 Number of Providers 35+ years (n=19) 86.7 100.0 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=65) 2 (n=24) 85.4 84.6 93.9 82.4 87.5 95.8 Married, First Birth (n=18) Unmarried, First Birth (n=30) 90.7 83.3 94.4 3+ (n=11) 85.0 66.7 88.9 87.6 93.3 96.7 Child's Gender Married, Repeat Birth (n=30) 82.5 76.7 96.7 Male (n=62) 84.6 87.1 95.2 Unmarried, Repeat Birth (n=45) Gestational Age 79.6 82.2 93.3 Female (n=62) 84.5 80.6 95.2 Metro Residence <37 weeks (n=10) 83.5 80.0 90.0 Metro (n=123) 83.9 83.7 95.1 37+ weeks (n=114) Provider Type 84.7 84.2 95.6 Non-metro (n=0) 86.4 - - Footnotes Public Sector Only (n=1) Private Sector Only (n=94) Both (n=6) Payment at Birth, Government Assist (n=53) Private Insurance (n=24) Other (n=10) Self Pay (n=19) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 100.0 83.0 83.3 100.0 94.7 83.3 81.1 91.7 90.0 79.0 96.2 95.8 90.0 94.7 49 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 3-3, Georgia Immunization Study Report, p4 covered by government-assisted insurance (91.7% vs. 81.1%). Children with two providers were more often UTD by 24 months than those with one provider (87.5% vs. 84.6%) but this may be explained by the larger number of children in the latter group. Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-3-F, column in italics). For example, children of mothers aged 25-34 years remained the least often UTD by the end of data collection compared to the other two groups (92.5%). Children whose mothers with some college education Children whose mothers are between 25-34 years of age Children of married mothers with previous children Children whose birth was covered by governmentassisted insurance Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 3-3 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of Hispanic mothers Table 3-3-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-3, 2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 70.7 84.2 83.5 85.4 86.6 82.3 59.2 - 2007 68.4 87.5 79.6 81.6 88.8 80.3 61.8 - 2008 69.3 79.7 78.7 74.8 84.2 79.2 70.8 - 2010 78.7 92.9 90.8 91.5 92.9 90.1 85.8 61.7 48.9 2011 88.5 97.1 93.3 94.2 97.1 94.2 98.1 81.7 47.2 2012 84.7 95.2 94.4 93.6 96.0 96.0 91.9 62.9 41.9 Immunization Rates by Vaccine Antigen: In District 33, the UTD immunization rates by 24 months steadily increased for all vaccine antigens through 2011. In 2012, most immunization rates by antigen fell slightly, though remained higher than rates in 2010. Both the MMR and the varicella UTD immunization rates rose in 2012 to 94.4% and 96.0% respectively (Table 3-2-G). Among District 3-3 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 84.7%, down from 88.5% in 2011. The UTD immunization rate for PCV was the second-lowest at 91.9%, down from 98.1% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District immunization campaigns. 50 District 3-4 2012 Georgia Immunization Study Report District 3-4 Data Collection Team Gloria Melvin District Immunization Coordinator County Sample Metro Gwinnett 152 Metro Newton 20 Metro Rockdale 23 Metro District 3-4 195 District UTD by 24 months 81.5% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Gwinnett Rockdale Newton 51 District 3-4 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 3-4 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (81.5% vs. 84.5%). At the end of data collection, the District UTD immunization rate remained lower than the state rate (91.8% vs. 93.6%) (Table 3-4-B). From 2011 to 2012: The District 3-4 UTD immunization rate by 24 months increased by 1.9% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 1.6% from 2011 to 2012 (Figure 3-4-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 3-4-A: GIS Sampling Scheme, District 3-4, 2012 District 3-4 (n) State (n) Original Sample 232 2,973 Ineligible 17 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 215 2,835 20 246 Final Sample 195 2,589 Response Rate (%) 90.7% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 3-4-B: Immunization Summary by Series & Vaccine Antigen, District 3-4, 2012 District State 3-4 Average (%) (%) UTD immunization rate* by 24 months 81.5 84.5 UTD immunization rate* by end of data collection 91.8 93.6 4 DTaP by 24 months 3 DTaP by 24 months 83.6 87.0 97.4 97.0 3 IPV by 24 months 95.9 96.0 1 MMR by 24 months 91.8 93.2 UTD Hib by 24 months 3 Hep B by 24 months 96.9 96.1 92.8 96.1 1 Varicella by 24 months 91.8 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 91.3 92.2 81.0 70.6 54.4 57.3 59.0 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 3-4-C: Georgia Immunization Study and District 3-4 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 3-4: UTD by 24 months Georgia: UTD by 24 months District 3-4: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 52 District 3-4, Georgia Immunization Study Report, p3 Table 3-4-F: UTD Immunization Rates by Demographic group, District 3-4, 2012 State Avg. UTD by 24 months (%) 3-4--UTD by 24 months % 3-4--UTD by end of d.c. (%) District 3-4 Sample (n=195) Maternal Race/Ethnicity, 84.5 81.5 91.8 White, NonHispanic (n=46) 85.0 78.3 87.0 White, Hispanic (n=21) 89.3 76.2 85.7 Black (n=58) 81.6 79.3 93.1 Unspecified, Hispanic (n=38) 86.5 84.2 97.4 Asian (n=12) 94.6 91.7 91.7 Multiracial (n=4) Maternal Education, 90.2 100.0 100.0 Some College+ (n=84) 86.6 84.5 89.3 HS Diploma/GED (n=55) 82.9 78.2 92.7 9th-11th grade (n=19) 82.9 68.4 89.5 <9th grade (n=25) 85.6 88.0 100.0 WIC Non-WIC (n=111) 89.4 90.1 93.7 UTD Immunization Rates by Demographic Group: In District 3-4, children of Asian mothers were more often UTD by 24 months compared to the District sample as a whole (91.7% vs. 81.5%). Children of white Hispanic mothers were least often UTD compared to the District sample as a whole (76.2% vs. 81.5%) (Table 3-4-F). In terms of maternal education, District 3-4 children of mothers with a college education and those of mothers with a <9th grade education were the most often UTD by 24 months (84.5% and 88.0% respectively). Children of mothers 35+ years of age were most often UTD by 24 months (87.9%). In terms of maternal marital status and repeat births, children of mothers with previous children were less often UTD by 24 months than first-born children (see Table 3-4-F). Additionally, the District data support the importance of a medical home (Number of Providers); children who had only one provider (82.5%) were more often UTD than those with more than one provider (see Table 3-4-F). Although most demographic-related disparities WIC (n=84) Maternal Age <25 years (n=66) 25-34 years (n=96) 87.0 84.5 90.5 83.6 78.8 92.4 State Avg. UTD by 24 months (%) 3-4--UTD by 24 months (%) 3-4--UTD by end of d.c. (%) 84.8 81.3 90.6 Number of Providers 35+ years (n=33) 86.7 87.9 Maternal Marital Status & Repeat Birth Combination 93.9 1 (n=97) 2 (n=39) 85.4 82.5 95.9 82.4 79.5 84.6 Married, First Birth (n=44) 90.7 84.1 90.9 3+ (n=18) 85.0 75.0 83.3 Unmarried, First Birth (n=34) 87.6 85.3 94.1 Child's Gender Married, Repeat Birth (n=75) 82.5 78.7 90.7 Male (n=99) 84.6 79.8 91.9 Unmarried, Repeat Birth (n=42) Gestational Age 79.6 81.0 92.9 Female (n=96) 84.5 83.3 91.7 Metro Residence <37 weeks (n=20) 83.5 60.0 80.0 Metro (n=195) 83.9 81.5 91.8 37+ weeks (n=175) Provider Type 84.7 84.0 93.1 Non-metro (n=0) 86.4 - - Footnotes Public Sector Only (n=5) Private Sector Only (n=143) Both (n=6) Payment at Birth, Government Assist (n=59) Private Insurance (n=61) Other (n=8) Self Pay (n=11) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 60.0 83.2 66.7 79.7 80.3 87.5 100.0 100.0 92.3 83.3 89.8 86.9 100.0 100.0 53 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 3-4, Georgia Immunization Study Report, p4 resolved by the end of data collection, some still remained and some new ones emerged (Table 3-4-F, column in italics). A new disparity was identified in District 3-4; children whose birth costs were covered by private insurance were less often UTD by the end of data collection than children whose birth was covered by governmentassisted insurance (86.9% vs. 89.8%). Children born at <37 weeks gestation Children receiving immunizations from more than one provider. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 3-4 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of white, Hispanic mothers Children whose mothers have not completed high school Children of mothers < 25 years of age. Children whose mothers have previous children Table 3-4-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-4, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 91.5 84.0 94.4 81.7 83.9 3 Polio by 24 months 96.6 90.1 95.8 88.3 96.1 1 MMR by 24 months 93.2 91.4 95.8 86.7 90.6 UTD Hib by 24 months 94.9 93.8 95.8 85.0 97.2 3 Hepatitis B by 24 months 94.9 92.6 95.8 90.0 93.3 1 Varicella by 24 months 94.0 93.8 94.4 90.0 91.7 UTD PCV by 24 months 92.3 85.2 97.2 88.3 97.8 2 Rotavirus - - - 75.0 91.7 1 Influenza by 24 months - - - 61.7 60.6 2012 83.6 95.9 91.8 96.9 92.8 91.8 91.3 81.0 59.0 Immunization Rates by Vaccine Antigen: In District 34, the UTD immunization rates by 24 months for most vaccine antigens fluctuated between 2006 and 2010, increased in 2011, and then decreased in 2012 (Table 3-4-G). Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, MMR, and varicella vaccines could reasonably be the primary focus of District and County-level immunization campaigns. Among District 3-4 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 83.6%, down from 83.9% in 2011. The UTD immunization rate for PCV was the second-lowest at 91.3%, down from 97.8% in 2011. 54 District 3-5 2012 Georgia Immunization Study Report District 3-5 Data Collection Team Jotonna Tulloch, BS District Immunization Coordinator Cassandra Jackson, LPN Primary Data Collector County Sample Metro DeKalb District 3-5 District UTD by 24 months Immunization Rate State of Georgia State UTD by 24 months Immunization Rate 150 150 87.3% 2,589 84.5% Metro DeKalb 55 District 3-5 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 3-5 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (87.3% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (98.0% vs. 93.6%) (Table 3-5-B). From 2011 to 2012: The District 3-5 UTD immunization rate by 24 months increased by 2.9% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 2.4% from 2011 to 2012 (Figure 3-5-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 3-5-A: GIS Sampling Scheme, District 3-5, 2012 District 3-5 State (n) (n) Original Sample 195 2,973 Ineligible 2 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 193 2,835 43 246 Final Sample 150 2,589 Response Rate (%) 83.4% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 3-5-B: Immunization Summary by Series & Vaccine Antigen, District 3-5, 2012 District State 3-5 Average (%) (%) UTD immunization rate* by 24 months 87.3 84.5 UTD immunization rate* by end of data collection 98.0 93.6 4 DTaP by 24 months 3 DTaP by 24 months 90.0 87.0 98.7 97.0 3 IPV by 24 months 98.0 96.0 1 MMR by 24 months 96.0 93.2 UTD Hib by 24 months 3 Hep B by 24 months 97.3 96.1 96.0 96.1 1 Varicella by 24 months 96.7 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 96.0 92.2 75.3 70.6 60.7 57.3 64.0 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 3-5-C: Georgia Immunization Study and District 3-5 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 3-5: UTD by 24 months Georgia: UTD by 24 months District 3-5: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 56 District 3-5, Georgia Immunization Study Report, p3 Table 3-5-F: UTD Immunization Rates by Demographic group, District 3-5, 2012 State Avg. UTD by 24 months (%) 3-5--UTD by 24 months % 3-5--UTD by end of d.c. (%) District 3-5 Sample (n=150) 84.5 87.3 98.0 Maternal Race/Ethnicity, UTD Immunization Rates by Demographic Group: In District 3-5, children of white, non-Hispanic mothers were more often UTD by 24 months compared to the District sample as a whole (91.2% vs. 87.3%). Children of Hispanic mothers were less often UTD compared to the District sample as a whole (82.6% vs. 87.3%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-5-F). White, NonHispanic (n=34) White, Hispanic (n=4) Black (n=69) Unspecified, Hispanic (n=19) Asian (n=8) Multiracial (n=2) Maternal Education, Some College+ (n=67) HS Diploma/GED (n=41) 9th-11th grade (n=12) 85.0 89.3 81.6 86.5 94.6 90.2 86.6 82.9 82.9 91.2 100.0 84.1 79.0 100.0 100.0 88.1 80.5 91.7 94.1 100.0 98.6 100.0 100.0 100.0 97.0 97.6 100.0 In terms of maternal education, District 3-5 children of mothers with a high school diploma/GED were least often UTD by 24 months (see Table 3-5F). District 3-5 children whose birth costs were covered by private insurance were more often UTD by 24 months than children whose birth was covered by government-assisted insurance (92.7% vs. 86.7%). Children receiving immunizations from one provider were more often UTD by 24 months than those receiving immunizations from two providers(88.0 vs. 76.2%). <9th grade (n=14) WIC Non-WIC (n=85) 85.6 89.4 100.0 96.5 100.0 98.8 To varying degrees, demographic-related disparities resolved by the end of data collection (Table 3-5-F, column in italics). WIC (n=65) Maternal Age <25 years (n=42) 25-34 years (n=85) 87.0 83.6 84.8 98.5 88.1 88.2 100.0 100.0 96.5 State Avg. UTD by 24 months (%) 3-5--UTD by 24 months (%) 3-5--UTD by end of d.c. (%) Number of Providers 35+ years (n=23) 86.7 82.6 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=75) 2 (n=21) 85.4 88.0 98.7 82.4 76.2 95.2 Married, First Birth (n=19) 90.7 89.5 94.7 3+ (n=9) 85.0 87.5 87.5 Unmarried, First Birth (n=37) 87.6 86.5 100.0 Child's Gender Married, Repeat Birth (n=53) 82.5 88.7 96.2 Male (n=73) 84.6 87.7 97.3 Unmarried, Repeat Birth (n=41) Gestational Age 79.6 85.4 100.0 Female (n=77) 84.5 87.0 98.7 Metro Residence <37 weeks (n=18) 83.5 88.9 94.4 Metro (n=150) 83.9 87.3 98.0 37+ weeks (n=132) Provider Type 84.7 87.1 98.5 Non-metro (n=0) 86.4 - - Footnotes Public Sector Only (n=0) Private Sector Only (n=99) Both (n=6) Payment at Birth, Government Assist (n=60) Private Insurance (n=55) Other (n=8) Self Pay (n=16) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 87.9 50.0 86.7 92.7 87.5 87.5 98.0 83.3 96.7 98.2 100.0 100.0 57 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 3-5, Georgia Immunization Study Report, p4 Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 3-5 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of Hispanic mothers Children whose birth costs were covered by government-assisted insurance Children receiving immunizations from more than one provider. Table 3-5-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-5, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 72.8 78.7 77.8 88.0 86.2 3 Polio by 24 months 80.3 85.1 82.1 94.7 97.8 1 MMR by 24 months 82.3 86.0 84.6 94.7 92.8 UTD Hib by 24 months 81.5 85.1 82.1 93.3 96.4 3 Hepatitis B by 24 months 80.3 87.8 84.0 94.7 98.6 1 Varicella by 24 months 82.3 85.5 84.0 94.7 93.5 UTD PCV by 24 months 66.7 77.4 81.5 90.7 97.8 2 Rotavirus - - - 76.0 91.3 1 Influenza by 24 months - - - 64.0 64.5 2012 90.0 98.0 96.0 97.3 96.0 96.7 96.0 75.3 64.0 Immunization Rates by Vaccine Antigen: In District 35, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2006 to 2008, and then increased from 2010 to 2012 (Table 3-5-G). Among District 3-5 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 90.0%, but rose from 86.2% in 2011. The UTD immunization rate for MMR was the second-lowest in 2011 but has risen to 96.0% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District immunization campaigns. 58 District 4-0 2012 Georgia Immunization Study Report District 4-0 Data Collection Team Amy Fenn, RN District Immunization Coordinator Darlene Sheets Secondary Data Collector County Sample Metro Butts 6 Metro Carroll 21 Metro Coweta 24 Nonmetro Fayette 10 Nonmetro Heard 1 Nonmetro Henry 49 Nonmetro Lamar 3 Nonmetro Meriwether 2 Metro Pike 5 Metro Spalding 8 Nonmetro Troup 15 Nonmetro Upson 7 Nonmetro District 4-0 151 District UTD by 24 months 88.1% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Carroll Heard Coweta Fayette Henry Spalding Butts Troup Meriwether Pike Lamar Upson 59 District 4-0 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 4-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (88.1% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (96.7% vs. 93.6%) (Table 4-0-B). From 2011 to 2012: The District 4-0 UTD immunization rate by 24 months increased by 8.4% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 8.0% from 2011 to 2012 (Figure 4-0-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 4-0-A: GIS Sampling Scheme, District 4-0, 2012 District 4-0 State (n) (n) Original Sample 184 2,973 Ineligible 2 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 182 2,835 31 246 Final Sample 151 2,589 Response Rate (%) 86.3% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 4-0-B: Immunization Summary by Series & Vaccine Antigen, District 4-0, 2012 District State 4-0 Average (%) (%) UTD immunization rate* by 24 months 88.1 84.5 UTD immunization rate* by end of data collection 96.7 93.6 4 DTaP by 24 months 3 DTaP by 24 months 89.4 87.0 98.7 97.0 3 IPV by 24 months 97.4 96.0 1 MMR by 24 months 96.7 93.2 UTD Hib by 24 months 3 Hep B by 24 months 98.7 96.1 98.7 96.1 1 Varicella by 24 months 98.7 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 96.0 92.2 66.2 70.6 62.3 57.3 51.7 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 4-0-C: Georgia Immunization Study and District 4-0 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 4-0: UTD by 24 months Georgia: UTD by 24 months District 4-0: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 60 District 4-0, Georgia Immunization Study Report, p3 Table 4-0-F: UTD Immunization Rates by Demographic group, District 4-0, 2012 State Avg. UTD by 24 months (%) 4-0--UTD by 24 months (%) 4-0--UTD by end of d.c. (%) District 4-0 Sample (n=151) Maternal Race/Ethnicity, 84.5 88.1 96.7 White, NonHispanic (n=79) 85.0 87.3 94.9 White, Hispanic (n=2) 89.3 100.0 100.0 Black (n=50) 81.6 88.0 98.0 UTD Immunization Rates by Demographic Group: In District 4-0, the UTD by 24 months immunization rates for the two largest race/ethnicity groups-- children of white, non-Hispanic mothers and children of black mothers, were above the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 4-0 -F). In terms of maternal education, children of mothers without a high school diploma or GED and no college education remained the least often UTD by 24 months among the maternal education groups (75.0%). Unspecified, Hispanic (n=9) Asian (n=4) Multiracial (n=3) Maternal Education, Some College+ (n=75) 86.5 88.9 100.0 In terms of maternal age, children of mothers in the 94.6 100.0 100.0 <25 years age group were least often UTD by 24 90.2 100.0 100.0 months of age (85.5%). In terms of maternal marital status and repeat births, children of unmarried mothers were less often UTD by 24 months than 86.6 89.3 97.3 children of married mothers (see Table 4-0-F). HS Diploma/GED (n=28) 9th-11th grade (n=32) <9th grade (n=3) WIC Non-WIC (n=94) 82.9 100.0 100.0 Children whose birth costs were covered by private 82.9 75.0 90.6 insurance were more likely to be UTD at 24 months than those whose birth costs were covered by 85.6 66.7 100.0 government assisted insurance. In District 4-0, children with one healthcare provider 89.4 94.7 97.9 were more often UTD by 24 months than those with WIC (n=57) Maternal Age <25 years (n=62) 25-34 years (n=69) 87.0 83.6 84.8 94.7 85.5 89.9 96.5 State Avg. 4-0--UTD 4-0--UTD UTD by 24 by 24 by end of months months d.c. 96.8 (%) (%) (%) 97.1 Number of Providers 35+ years (n=20) 86.7 90.0 Maternal Marital Status & Repeat Birth Combination 95.0 1 (n=77) 2 (n=34) 85.4 92.2 98.7 82.4 79.4 88.2 Married, First Birth (n=36) 90.7 94.4 97.2 3+ (n=18) 85.0 85.7 100.0 Unmarried, First Birth (n=32) 87.6 87.5 100.0 Child's Gender Married, Repeat Birth (n=49) 82.5 89.8 100.0 Male (n=84) 84.6 86.9 96.4 Unmarried, Repeat Birth (n=34) Gestational Age 79.6 79.4 88.2 Female (n=67) 84.5 89.6 97.0 Metro Residence <37 weeks (n=13) 83.5 84.6 100.0 Metro (n=129) 83.9 86.8 96.1 37+ weeks (n=138) Provider Type 84.7 88.4 96.4 Non-metro (n=22) 86.4 95.5 Footnotes 100.0 Public Sector Only (n=5) Private Sector Only (n=110) Both (n=14) Payment at Birth, Government Assist (n=59) Private Insurance (n=60) Other (n=10) Self Pay (n=3) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 80.0 90.0 64.3 81.4 91.7 90.0 100.0 80.0 97.3 92.9 94.9 98.3 90.0 100.0 61 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 4-0, Georgia Immunization Study Report, p4 two providers (92.2% vs. 79.4%). In addition, children living in metro counties (see page 1 of District 4-0 Immunization Report) were less often UTD by 24 months than those living in non-metro counties (86.8% vs. 95.5%). Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 4-0-F, column in italics). For example, children of mothers without a high school diploma or GED and no college education remained the least often UTD by the end of the data collection (90.6%). Children residing in metro counties remained slightly less often UTD by the end of the data collection than children living in non-metro counties (96.1% vs. 100%). Children of mothers with previous children Children with two healthcare providers as opposed to one Children living in metro counties (see page 1 of District 4-0 Immunization Report) Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 4-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children whose mothers have no high school or college education Children of mothers <25 years of age Table 4-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 4-0, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 71.7 78.2 74.6 88.5 84.2 3 Polio by 24 months 88.0 92.4 85.4 96.6 97.1 1 MMR by 24 months 80.4 84.0 86.0 87.9 92.4 UTD Hib by 24 months 83.7 88.4 81.6 87.9 94.7 3 Hepatitis B by 24 months 89.1 91.6 86.5 97.1 97.1 1 Varicella by 24 months 82.1 85.8 84.3 89.7 93.0 UTD PCV by 24 months 66.3 80.0 81.1 89.7 96.5 2 Rotavirus - - - 69.5 79.5 1 Influenza by 24 months - - - 56.9 57.9 2012 89.4 97.4 96.7 98.7 98.7 98.7 96.1 66.2 51.7 Immunization Rates by Vaccine Antigen: In District 40, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2005 to 2008, but then increased steadily through 2012 (Table 4-0G). Among District 4-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 89.4%, but rose from 88.5% in 2010. The UTD immunization rate for MMR rose from 87.9% in 2010 to 96.7% in 2012. The PCV UTD immunization rate was the only major antigen that decreased but only to 96.1% from 96.5% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District and County -level immunization campaigns. 62 District 5-1 2012 Georgia Immunization Study Report District 5-1 Data Collection Team Patty Portwood, BS, Ed District Immunization Coordinator Additional Data Collection Staff JIna Adams, RN, MSN Brenda Clarke, RN Kitty Coleman Donna Collins, RN Terri Griffin, RN Mable Harden, RN Daphenia Harmon Daisy Haines, RN Allison Ledford, LPN Debbie Martin, RNC Wanda Moore, RNC Mary Powell, RN Brittany Swain, LPN Amy Tanner, RN Suzanne Usher, RN Brenda Williams, RN Joni R. Wilson, RN Montgomery County Sample Metro Bleckley 10 Nonmetro Dodge 14 Nonmetro Johnson 3 Nonmetro Laurens 27 Nonmetro Montgomery 4 Nonmetro Pulaski 3 Nonmetro Telfair 3 Nonmetro Treutlen 6 Nonmetro Wheeler 3 Nonmetro Wilcox 4 Nonmetro District 5-1 77 District UTD by 24 months 77.9% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Johnson Bleckley Laurens Treutlen Pulaski Dodge Wheeler Wilcox Telfair 63 District 5-1 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 5-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (77.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was equal to the state rate (93.5% vs. 93.6%) (Table 5-1-B). Table 5-1-B: Immunization Summary by Series & Vaccine Antigen, District 5-1, 2012 District State 5-1 Average (%) (%) From 2011 to 2012: The District 5-1 UTD immunization rate by 24 months decreased by 2.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 0.5% from 2011 to 2012 (Figure 5-1-C). UTD immunization rate* by 24 months UTD immunization rate* by end of data collection 77.9 84.5 93.5 93.6 Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. 4 DTaP by 24 months 3 DTaP by 24 months 79.2 87.0 94.8 97.0 Table 5-1-A: GIS Sampling Scheme, District 5-1, 2012 3 IPV by 24 months 1 MMR by 24 months 92.2 96.0 85.7 93.2 District 5-1 State (n) (n) Original Sample 87 2,973 Ineligible 4 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 83 2,835 6 246 Final Sample 77 2,589 Response Rate (%) 94.0% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. UTD Hib by 24 months 90.9 96.1 3 Hep B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 96.1 96.1 87.0 94.2 89.6 92.2 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 45.5 70.6 54.5 57.3 46.8 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 5-1-C: Georgia Immunization Study and District 5-1 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 5-1: UTD by 24 months District 5-1: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 64 District 5-1, Georgia Immunization Study Report, p3 Table 5-1-F: UTD Immunization Rates by Demographic group, District 5-1, 2012 State Avg. UTD by 24 months (%) 5-1--UTD by 24 months (%) 5-1--UTD by end of d.c. (%) UTD Immunization Rates by Demographic Group: In District 5-1, the UTD by 24 months immunization rates for the largest racial/ethnic groups - children of white, non-Hispanic mothers and children of black mothers, were below the state average as were the District rates as a whole (Table 5-1-F). District 5-1 Sample (n=77) Maternal Race/Ethnicity, White, NonHispanic (n=38) White, Hispanic (n=3) Black (n=31) Unspecified, Hispanic (n=2) Asian (n=1) Multiracial (n=0) Maternal Education, Some College+ (n=24) HS Diploma/GED (n=23) 84.5 77.9 93.5 In terms of maternal education, children of mothers with the lowest level of education (<9th grade) were the least often UTD by 24 months (66.7%) though this 85.0 76.3 89.5 was a small sample size; the remaining groups had 89.3 100.0 similar though somewhat higher rates. 100.0 81.6 77.4 96.8 Surprisingly, in terms of WIC enrollment, children not enrolled in WIC were more often UTD by 24 months 86.5 50.0 100.0 than those enrolled in WIC (97.4% vs. 76.3%). 94.6 100.0 100.0 90.2 - - In terms of maternal age, children of mothers <25 years were the least often UTD by 24 months (75.0%). In terms of maternal marital status and repeat births, children of unmarried mothers with 86.6 79.2 95.8 first birth children were the least often UTD by 24 82.9 82.6 91.3 months (64.3%). 9th-11th grade (n=15) <9th grade (n=3) WIC Non-WIC (n=39) 82.9 80.0 100.0 Children whose birth costs were covered by private 85.6 66.7 100.0 insurance were more likely to be UTD by 24 months (80.0%) than those whose birth costs were covered through government assisted insurance (72.6%). 89.4 97.4 97.4 WIC (n=38) Maternal Age <25 years (n=28) 25-34 years (n=40) 87.0 83.6 84.8 76.3 75.0 80.0 94.7 100.0 87.5 State Avg. UTD by 24 months (%) 5-1--UTD by 24 months (%) 5-1--UTD by end of d.c. (%) Number of Providers 35+ years (n=9) 86.7 77.8 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=49) 2 (n=17) 85.4 82.4 77.6 88.2 93.9 100.0 Married, First Birth (n=11) 90.7 90.9 90.9 3+ (n=3) 85.0 66.7 100.0 Unmarried, First Birth (n=14) 87.6 64.3 100.0 Child's Gender Married, Repeat Birth (n=31) 82.5 77.4 93.6 Male (n=40) 84.6 77.5 95.0 Unmarried, Repeat Birth (n=20) Gestational Age 79.6 80.0 90.0 Female (n=37) 84.5 78.4 91.9 Metro Residence <37 weeks (n=3) 83.5 100.0 100.0 Metro (n=0) 83.9 - - 37+ weeks (n=74) Provider Type 84.7 77.0 93.2 Non-metro (n=77) 86.4 77.9 93.5 Footnotes Public Sector Only (n=4) Private Sector Only (n=54) Both (n=11) Payment at Birth, Government Assist (n=51) Private Insurance (n=15) Other (n=3) Self Pay (n=1) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 50.0 83.3 72.7 72.6 80.0 100.0 100.0 75.0 96.3 100.0 92.2 93.3 100.0 100.0 65 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 5-1, Georgia Immunization Study Report, p4 The District 5-2 data do not support the importance of a medical home; children who had two providers (Number of Providers) were more often UTD by 24 months (88.2%). Although many demographic-related disparities resolved by the end of data collection, some still remained and a new one was identified (Table 5-1-F, column in italics). Children of white, non-Hispanic mothers remained less often UTD than children of other racial/ethnic groups. Oddly, children with one provider remained less often UTD than children with two providers by the end of data collection (93.9% vs. 100.0%). Children of mothers aged 25-34 years became the least often UTD while those <25 years were brought up to date (87.5% vs. 100%) by the end of data collection. Children of mothers having less than a high school education Children of mothers <25 years of age Children of unmarried mothers with no previous children Children whose birth costs were covered by government- assisted insurance Children with only one provider administering immunizations Children enrolled in the WIC program Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 5-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Table 5-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 5-1, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 81.3 74.2 78.7 85.1 80.0 3 Polio by 24 months 91.7 95.5 93.4 95.5 94.0 1 MMR by 24 months 97.9 84.9 90.2 92.5 94.0 UTD Hib by 24 months 89.6 86.4 86.9 89.6 90.0 3 Hepatitis B by 24 months 97.9 92.4 98.4 98.5 98.0 1 Varicella by 24 months 89.6 86.4 90.2 94.0 96.0 UTD PCV by 24 months 85.4 74.2 86.9 95.5 96.0 2 Rotavirus - - - 50.7 66.0 1 Influenza by 24 months - - - 46.3 44.0 2012 79.2 92.2 85.7 90.9 96.1 87.0 89.6 45.5 46.8 Immunization Rates by Vaccine Antigen: In District 51, the UTD immunization rate by 24 months for most vaccine antigens fluctuated from 2006 to 2012 (Table 5 -1-G). Among District 5-1 immunization rates by vaccine antigen in 2012, the UTD by 24 months of age immunization rate for DTaP was the lowest at 79.2%, down from 85.1% in 2010. The UTD immunization rate for MMR was second-lowest at 85.7%, similar to 84.9% in 2007. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, MMR, varicella, and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 66 District 5-2 2012 Georgia Immunization Study Report District 5-2 Data Collection Team Judy McChargue, RN District Immunization Coordinator County Sample Metro Baldwin 18 Nonmetro Bibb 59 Metro Crawford 0 Metro Hancock 0 Nonmetro Houston 35 Metro Jasper 6 Metro Jones 5 Metro Monroe 4 Metro Peach 18 Nonmetro Putnam 3 Nonmetro Twiggs 3 Metro Washington 3 Nonmetro Wilkinson 4 Nonmetro District 5-2 158 District UTD by 24 months 85.4% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Jasper Putnam Hancock Monroe Baldwin Jones Washington Bibb Crawford Wilkinson Twiggs Peach Houston 67 District 5-2 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 5-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was slightly higher than the state rate (85.4% vs. 84.5%). By the end of data collection, the District UTD immunization rate was similar to the state rate (93.7% vs. 93.6%) (Table 5-2-B). From 2011 to 2012: The District 5-2 UTD immunization rate by 24 months increased by 2.3% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 5.4% from 2011 to 2012 (Figure 5-2-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 5-2-A: GIS Sampling Scheme, District 5-2, 2012 District 5-2 (n) State (n) Original Sample 166 2,973 Ineligible 4 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 162 2,835 4 246 Final Sample 158 2,589 Response Rate (%) 97.5% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 5-2-B: Immunization Summary by Series & Vaccine Antigen, District 5-2--2012 District State 5-2 Average (%) (%) UTD immunization rate* by 24 months 85.4 84.5 UTD immunization rate* by end of data collection 93.7 93.6 4 DTaP by 24 months 3 DTaP by 24 months 86.1 87.0 96.8 97.0 3 IPV by 24 months 95.6 96.0 1 MMR by 24 months 93.0 93.2 UTD Hib by 24 months 3 Hep B by 24 months 95.6 96.1 96.2 96.1 1 Varicella by 24 months 94.3 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 91.8 92.2 52.5 70.6 57.6 57.3 50.6 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 5-2-C: Georgia Immunization Study and District 5-2 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 5-2: UTD by 24 months Georgia: UTD by 24 months District 5-2: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 68 District 5-2, Georgia Immunization Study Report, p3 Table 5-2-F: UTD Immunization Rates by Demographic group, District 5-2, 2012 State Avg. UTD by 24 months (%) 5-2--UTD by 24 months (%) 5-2--UTD by end of d.c. (%) District 5-2 Sample (n=158) 84.5 85.4 93.7 Maternal Race/Ethnicity, UTD Immunization Rates by Demographic Group: In District 5-2, children of black mothers were less often UTD by 24 months among the maternal race/ ethnicity groups (83.3%). The UTD by 24 months immunization rates for children of white, nonHispanic mothers were similar to the District sample overall(85.5% vs. 85.4%). The other race/ ethnicity group sample sizes were too small to draw any definite conclusions (Table 5-2-F). White, NonHispanic (n=76) White, Hispanic (n=5) Black (n=72) Unspecified, Hispanic (n=2) 85.0 85.5 94.7 In terms of maternal education, children of mothers with a high school diploma or GED and no 89.3 100.0 100.0 college education were the least often UTD by 24 81.6 83.3 91.7 months among the maternal education groups 86.5 100.0 (80.8%). 100.0 Asian (n=1) Multiracial (n=1) Maternal Education, Some College+ (n=72) HS Diploma/GED (n=52) 9th-11th grade (n=23) <9th grade (n=6) WIC Non-WIC (n=85) 94.6 100.0 100.0 Children of mothers with maternal age <25 years were least likely to be UTD by 24 months (84.1%). 90.2 100.0 100.0 In terms of maternal marital status and repeat births, children of mothers with previous children were the least often UTD by 24 months, (see Table 86.6 88.9 95.8 5-2-F). 82.9 80.8 90.4 Children in District 5-2 whose birth costs were 82.9 91.3 95.7 covered by private insurance were more often UTD 85.6 83.3 100.0 by 24 months than those whose birth costs were covered by government-assisted insurance (91.3% vs. 83.2%). In addition, the District data support 89.4 94.1 96.5 the importance of a medical home; children who WIC (n=73) Maternal Age <25 years (n=69) 25-34 years (n=78) 87.0 83.6 84.8 86.3 84.1 85.9 90.4 State Avg. 5-2--UTD 5-2--UTD UTD by 24 by 24 by end of months months d.c. 92.8 (%) (%) (%) 94.9 Number of Providers 35+ years (n=11) 86.7 90.9 Maternal Marital Status & Repeat Birth Combination 90.9 1 (n=99) 2 (n=21) 85.4 84.9 95.0 82.4 76.2 90.5 Married, First Birth (n=25) Unmarried, First Birth (n=38) 90.7 87.6 100.0 89.5 100.0 97.4 3+ (n=7) Child's Gender 85.0 100.0 100.0 Married, Repeat Birth (n=39) 82.5 82.1 92.3 Male (n=78) 84.6 88.5 96.2 Unmarried, Repeat Birth (n=56) Gestational Age 79.6 78.6 89.3 Female (n=80) 84.5 82.5 91.3 Metro Residence <37 weeks (n=26) 83.5 84.6 96.2 Metro (n=116) 83.9 84.5 92.2 37+ weeks (n=132) Provider Type 84.7 85.6 93.2 Non-metro (n=42) 86.4 88.1 97.6 Footnotes Public Sector Only (n=2) Private Sector Only (n=115) Both (n=10) Payment at Birth, Government Assist (n=101) Private Insurance (n=46) Other (n=3) Self Pay (n=6) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 50.0 86.1 70.0 83.2 91.3 66.7 100.0 100.0 94.8 90.0 93.1 95.7 100.0 100.0 69 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 5-2, Georgia Immunization Study Report, p4 had one provider (Number of Providers) were more often UTD by 24 months than those with two providers (84.9% vs. 76.2%). To varying degrees, demographic-related disparities improved by the end of data collection (Table 5-2-F, column in italics). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 5-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of black mothers Children of mothers with a high school diploma or GED, but no college education Children of mothers with previous children Children whose birth costs were covered by government-assisted insurance Children receiving immunizations from two different providers Table 5-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 5-2, 2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 86.3 95.4 93.1 92.4 93.9 93.9 75.6 - 2007 76.9 91.0 84.6 82.1 88.5 84.6 78.2 - 2008 81.3 88.8 89.6 85.8 91.0 88.1 85.1 - 2010 81.2 95.5 93.2 90.2 97.0 95.5 90.2 65.4 49.6 2011 87.6 96.9 96.9 94.9 97.9 96.9 97.9 68.0 53.6 2012 86.1 95.6 93.0 95.6 96.2 94.3 91.8 52.5 50.6 Immunization Rates by Vaccine Antigen: In District 52, the UTD immunization rate by 24 months for most vaccine antigens fluctuated from 2006 to 2010, increasing to highest rates for most antigens in 2011, then falling slightly in 2012 (Table 5-2-G). Among District 5-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 86.1%, down from 87.6% in 2011. The UTD immunization rate for PCV was second-lowest at 91.8%, down from 97.9% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine should be the primary focus of District and County-level immunization campaigns. 70 District 6-0 2012 Georgia Immunization Study Report District 6-0 Data Collection Team Susan Edmunds, RN District Immunization Coordinator Clois Witt, RN Primary Data Collector County Sample Metro Burke 11 Metro Columbia 13 Metro Emanuel 10 Nonmetro Glascock 0 Nonmetro Jefferson 8 Nonmetro Jenkins 4 Nonmetro Lincoln 3 Nonmetro McDuffie 9 Metro Richmond 89 Metro Screven 5 Nonmetro Taliaferro 1 Nonmetro Warren 1 Nonmetro Wilkes 5 Nonmetro District 6-0 159 District UTD by 24 months 82.4% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Wilkes Lincoln Taliaferro Columbia McDuffie Warren Richmond Glascock Jefferson Burke Jenkins Emanuel Screven 71 District 6-0 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 6-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (82.4% vs. 84.5%). By the end of data collection, the District UTD immunization rate was similar to the state rate (93.7% vs. 93.6%) (Table 6-0-B). From 2011 to 2012: The District 6-0 UTD immunization rate by 24 months increased by 4.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 5.2% from 2011 to 2012 (Figure 6-0-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 6-0-A: GIS Sampling Scheme, District 6-0, 2012 District 6-0 State (n) (n) Original Sample 174 2,973 Ineligible 14 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 160 2,835 1 246 Final Sample 159 2,589 Response Rate (%) 99.4% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 6-0-B: Immunization Summary by Series & Vaccine Antigen, District 6-0, 2012 District State 6-0 Average (%) (%) UTD immunization rate* by 24 months UTD immunization rate* by end of data collection 4 DTaP by 24 months 3 DTaP by 24 months 82.4 84.5 93.7 93.6 84.3 87.0 96.3 97.0 3 IPV by 24 months 95.6 96.0 1 MMR by 24 months UTD Hib by 24 months 3 Hep B by 24 months 89.9 93.2 93.7 96.1 93.7 96.1 1 Varicella by 24 months 91.8 94.2 UTD PCV by 24 months 88.1 92.2 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 62.9 70.6 47.8 57.3 52.2 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 6-0-C: Georgia Immunization Study and District 6-0 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 6-0: UTD by 24 months Georgia: UTD by 24 months District 6-0: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 72 District 6-0, Georgia Immunization Study Report, p3 Table 6-0-F: UTD Immunization Rates by Demographic group, District 6-0, 2012 State Avg. 6-0--UTD UTD by 24 by 24 months months (%) (%) 6-0--UTD by end of d.c. (%) District 6-0 Sample (n=159) 84.5 82.4 93.7 Maternal Race/Ethnicity, White, NonHispanic (n=50) 85.0 86.0 96.0 White, Hispanic (n=3) 89.3 100.0 100.0 UTD Immunization Rates by Demographic Group: In District 6-0, children of black mothers were less often UTD by 24 months than children of white, non -Hispanic mothers (79.6.4% vs. 86.0%) and lower than the District rate as a whole (82.4%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 6-0-F). In terms of maternal education, children of mothers with a high school diploma/GED or some college education were more often UTD by 24 months than children of mothers with less education. Black (n=93) Unspecified, Hispanic (n=5) Asian (n=1) Multiracial (n=4) Maternal Education, Some College+ (n=58) HS Diploma/GED (n=63) 9th-11th grade (n=34) <9th grade (n=4) WIC Non-WIC (n=76) 81.6 79.6 92.5 In terms of maternal age, higher maternal age was 86.5 60.0 80.0 associated with higher UTD immunization rates by 24 months of age (see Table 6-0-F). In terms of the 94.6 100.0 100.0 maternal marital status and repeat births, children 90.2 100.0 100.0 of married mothers were more often UTD by 24 months than children of unmarried mothers (see Table 6-0-F). Children of unmarried mothers who 86.6 89.7 already had at least one other child were least 96.6 often UTD at 24 months (73.0%). 82.9 85.7 92.1 82.9 67.7 94.1 Children born at a gestational age of less than 37 weeks were less often UTD by 24 months than those 85.6 50.0 75.0 born at a gestational age of more than 37 weeks (78.3% vs. 83.1%). 89.4 88.2 97.4 Children whose birth costs were covered by WIC (n=83) Maternal Age <25 years (n=71) 25-34 years (n=74) 87.0 80.7 83.6 84.8 81.7 82.4 90.4 State Avg. 6-0--UTD 6-0--UTD UTD by 24 by 24 by end of months months d.c. 94.4 (%) (%) (%) 91.9 Number of Providers 35+ years (n=14) 86.7 85.7 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=98) 2 (n=18) 85.4 87.8 94.9 82.4 72.2 94.4 Married, First Birth (n=16) 90.7 93.8 93.8 3+ (n=10) 85.0 50.0 90.0 Unmarried, First Birth (n=44) 87.6 86.4 100.0 Child's Gender Married, Repeat Birth (n=36) 82.5 88.9 97.2 Male (n=68) 84.6 86.8 97.1 Unmarried, Repeat Birth (n=63) Gestational Age 79.6 73.0 87.3 Female (n=91) 84.5 79.1 91.2 Metro Residence <37 weeks (n=23) 83.5 78.3 95.7 Metro (n=120) 83.9 80.8 92.5 37+ weeks (n=136) Provider Type 84.7 83.1 93.4 Non-metro (n=39) 86.4 87.2 97.4 Footnotes Public Sector Only (n=4) Private Sector Only (n=104) Both (n=18) Payment at Birth, Government Assist (n=116) Private Insurance (n=36) Other (n=1) Self Pay (n=3) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 75.0 87.5 55.6 80.2 88.9 100.0 66.7 100.0 95.2 88.9 92.2 100.0 100.0 66.7 73 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 6-0, Georgia Immunization Study Report, p4 government-assisted insurance were less likely to be UTD at 24 months and accounted for the majority of the children sampled in this District (80.2%). The District data support the importance of a medical home; children who had one provider were more often UTD by 24 months than those with two providers (87.8% vs. 72.2%). Additionally, children residing in non-metro counties (see page 1 of District 6-0 Immunization Report) were more often UTD by 24 months than those residing in metro counties (87.2% vs. 80.8%). To varying degrees, most demographic-related disparities resolved by the end of data collection (Table 6-0-F, column in italics). Some disparities in terms of lower immunization rates in District 6-0 remained at the end of the study. These were among children of black and unspecified Hispanic mothers, children of mothers with less than a high school education, children of unmarried mothers with previous children, children whose birth costs were covered by government-assisted insurance, and children living in metro counties (see page 1 of District 6-0 Immunization Report). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 6-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of black mothers Children of mothers without a high school diploma/ GED education Children with mothers under 25 years of age Children of unmarried mothers with previous children Children who were born at a gestational age of less than 37 weeks Children whose birth costs were covered by government-assisted insurance Children who receive immunizations from 2 providers instead of one Children residing in metro counties (see page 1 of District 6-0 Immunization Report) Table 6-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 6-0, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 89.2 89.4 84.4 80.0 80.0 3 Polio by 24 months 98.7 97.9 100 95.6 97.7 1 MMR by 24 months 93.2 95.7 95.6 93.3 91.8 UTD Hib by 24 months 94.6 97.9 97.8 91.1 95.3 3 Hepatitis B by 24 months 100 97.9 100 93.3 98.8 1 Varicella by 24 months 96.0 97.9 91.1 93.3 94.1 UTD PCV by 24 months 91.9 93.6 95.6 84.4 98.8 2 Rotavirus - - - 60.0 75.3 1 Influenza by 24 months - - - 53.3 61.2 2012 84.3 95.6 89.9 93.7 93.7 91.8 88.1 62.9 52.2 Immunization Rates by Vaccine Antigen: In District 60, the UTD immunization rate by 24 months for most vaccine antigens remained somewhat steady from 2006 to 2010, with some note-worthy increases in 2011, particularly for PCV, which increased from 84.4% in 2010 to 98.8% in 2011. Subsequently rates for almost all vaccine antigens fell in 2012 (Table 6-0-G). Among District 6-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 84.3%, although this was higher than in 2011 (80.0%). The UTD immunization rate for PCV was second-lowest at 88.1%, down from 98.8% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, PCV, and MMR vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 74 District 7-0 2012 Georgia Immunization Study Report District 7-0 Data Collection Team Dianne Robinson, RN, MSN District Immunization Coordinator County Sample Metro Chattahoochee 2 Metro Clay 0 Nonmetro Crisp 11 Nonmetro Dooly 6 Nonmetro Harris 11 Metro Macon 4 Nonmetro Marion 5 Metro Muscogee 83 Metro Quitman 0 Nonmetro Randolph 7 Nonmetro Schley 3 Nonmetro Stewart 1 Nonmetro Sumter 21 Nonmetro Talbot 1 Nonmetro Taylor 1 Nonmetro Webster 0 Nonmetro District 7-0 156 District UTD by 24 months 91.0% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Harris Talbot Muscogee Taylor Chatta- Marion hoochee Macon Schley Stewart Webster Quitman Randolph Sumter Dooly Crisp Clay 75 District 7-0 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 7-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (91.0% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (98.7% vs. 93.6%) (Table 7-0-B). From 2011 to 2012: The District 7-0 UTD immunization rate by 24 months increased by 16.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 10.2% from 2011 to 2012 (Figure 7-0-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 7-0-A: GIS Sampling Scheme, District 7-0, 2012 District 7-0 State (n) (n) Original Sample 179 2,973 Ineligible 6 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 173 2,835 17 246 Final Sample 156 2,589 Response Rate (%) 92.5% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 7-0-B: Immunization Summary by Series & Vaccine Antigen, District 7-0, 2012 District State 7-0 Average (%) (%) UTD immunization rate* by 24 months 91.0 84.5 UTD immunization rate* by end of data collection 98.7 93.6 4 DTaP by 24 months 3 DTaP by 24 months 93.6 87.0 99.4 97.0 3 IPV by 24 months 98.7 96.0 1 MMR by 24 months 96.8 93.2 UTD Hib by 24 months 3 Hep B by 24 months 98.7 96.1 99.4 96.1 1 Varicella by 24 months 96.2 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 95.5 92.2 65.4 70.6 63.5 57.3 59.0 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 7-0-C: Georgia Immunization Study and District 7-0 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 7-0: UTD by 24 months District 7-0: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 76 District 7-0, Georgia Immunization Study Report, p3 Table 7-0-F: UTD Immunization Rates by Demographic group, District 7-0, 2012 State Avg. UTD by 24 months (%) 7-0--UTD by 24 months (%) 7-0--UTD by end of d.c. (%) District 7-0 Sample (n=156) 84.5 91.0 98.7 UTD Immunization Rates by Demographic Group: In District 7-0, the UTD by 24 months immunization rates for children of black mothers were lower than that for children of white, non-Hispanic mothers (89.5% vs. 93.9%) and lower than the District rate as a whole (91.0%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 7-0-F). Maternal Race/Ethnicity, White, NonHispanic (n=49) White, Hispanic (n=0) Children of mothers with less than a high school 85.0 93.9 100.0 education were the least often UTD by 24 months (85.7%), but were also the smallest group. 89.3 - - Black (n=86) Unspecified, Hispanic (n=7) Asian (n=3) Multiracial (n=2) Maternal Education, Some College+ (n=64) HS Diploma/GED (n=50) 9th-11th grade (n=34) 81.6 89.5 98.8 In terms of maternal age, children of mothers 25-34 years of age were the most often UTD by 24 months 86.5 85.7 85.7 (97.1%). In terms of maternal marital status and 94.6 66.7 100.0 repeat births, children of married mothers without previous children were slightly less often UTD by 24 90.2 100.0 100.0 months (see Table 7-0-F). Children whose birth costs were covered by 86.6 93.8 98.4 government-assisted insurance were less often UTD 82.9 88.0 100.0 by 24 months than those whose birth was covered 82.9 91.2 by private insurance (88.2% vs. 96.7%). 100.0 <9th grade (n=7) WIC Non-WIC (n=67) 85.6 85.7 85.7 Children living in metro counties (see page 1 of District 7-0 Immunization Report) were less often UTD by 24 months of age than children living in non 89.4 95.5 98.5 -metro counties (89.2% vs. 94.4%). WIC (n=89) Maternal Age <25 years (n=79) 25-34 years (n=69) 87.0 83.6 84.8 91.0 86.1 97.1 100.0 98.7 98.6 State Avg. UTD by 24 months % Number of Providers 7-0--UTD by 24 months (%) 7-0--UTD by end of d.c. (%) 35+ years (n=8) 86.7 87.5 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=66) 2 (n=31) 85.4 82.4 90.9 93.6 100.0 100.0 Married, First Birth (n=14) 90.7 85.7 92.9 3+ (n=15) 85.0 93.3 100.0 Unmarried, First Birth (n=47) 87.6 91.5 100.0 Child's Gender Married, Repeat Birth (n=40) 82.5 92.5 100.0 Male (n=77) 84.6 94.8 98.7 Unmarried, Repeat Birth (n=55) Gestational Age 79.6 90.9 98.2 Female (n=79) 84.5 87.3 98.7 Metro Residence <37 weeks (n=25) 83.5 88.0 100.0 Metro (n=102) 83.9 89.2 98.0 37+ weeks (n=131) Provider Type 84.7 91.6 98.5 Non-metro (n=54) 86.4 94.4 Footnotes 100.0 Public Sector Only (n=1) Private Sector Only (n=101) Both (n=10) Payment at Birth, Government Assist (n=85) Private Insurance (n=30) Other (n=22) Self Pay (n=9) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 100.0 93.1 80.0 88.2 96.7 100.0 77.8 100.0 100.0 100.0 98.8 100.0 100.0 88.9 77 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 7-0, Georgia Immunization Study Report, p4 Almost all demographic-related disparities resolved by the end of data collection(Table 7-0-F, column in italics). Children of married mothers with no previous children remained slightly less likely to be UTD by the end of data collection than the District rate as a whole (92.9% vs. 98.7%). Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 7-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of black mothers Children of mothers with no high school education Children of mothers from <25 years of age Children of married mothers with no previous children Children living in metro counties (see page 1 of District 7-0 Immunization Report) Table 7-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 7-0--2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 85.0 75.2 79.5 83.7 80.9 3 Polio by 24 months 94.0 84.8 90.7 95.4 95.7 1 MMR by 24 months 92.0 88.6 88.7 89.9 92.2 UTD Hib by 24 months 92.0 90.5 88.1 91.5 94.8 3 Hepatitis B by 24 months 95.0 89.5 88.1 93.0 98.3 1 Varicella by 24 months 94.0 87.6 88.7 93.0 93.0 UTD PCV by 24 months 75.0 81.0 84.1 86.8 95.7 2 Rotavirus - - - 83.7 83.5 1 Influenza by 24 months - - - 67.4 60.0 2012 93.6 98.7 96.8 98.7 99.4 96.2 95.5 65.4 59.0 Immunization Rates by Vaccine Antigen: In District 70, the UTD immunization rate by 24 months for most vaccine antigens remained somewhat steady from 2006 to 2010, with some note-worthy increases in 2011, and again in 2012 (Table 7-0-G). from 95.7% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District and County -level immunization campaigns. Among District 7-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 93.6% although this was markedly elevated from 80.9% in 2011. The UTD immunization rate for PCV was second-lowest at 95.5%, down slightly 78 District 8-1 2012 Georgia Immunization Study Report District 8-1 Data Collection Team Debra Adams, RN, APRN District Immunization Coordinator January Smith, MPH District Epidemiologist County Sample Metro Ben Hill 4 Nonmetro Berrien 9 Nonmetro Brooks 4 Metro Cook 7 Nonmetro Echols 0 Metro Irwin 2 Nonmetro Lanier 3 Metro Lowndes 41 Metro Tift 11 Nonmetro Turner 0 Nonmetro District 8-1 81 District UTD by 24 months 88.9% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Turner Tift Ben Hill Irwin Berrien Cook Lanier Brooks Lowndes Echols 79 District 8-1 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 8-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (88.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (96.3% vs. 93.6%) (Table 8-1-B). From 2011 to 2012: The District 8-1 UTD immunization rate by 24 months decreased by 2.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 0.2% from 2011 to 2012 (Figure 8-1-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 8-1-A: GIS Sampling Scheme, District 8-1, 2012 Table 8-1-B: Immunization Summary by Series & Vaccine Antigen, District 8-1, 2012 District State 8-1 Average (%) (%) UTD immunization rate* by 24 months UTD immunization rate* by end of data collection 4 DTaP by 24 months 3 DTaP by 24 months 3 IPV by 24 months 88.9 84.5 96.3 93.6 90.1 87.0 98.8 97.0 98.8 96.0 1 MMR by 24 months 95.1 93.2 District 8-1 State (n) (n) Original Sample 87 2,973 Ineligible 0 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 87 2,835 6 246 Final Sample 81 2,589 Response Rate (%) 93.1% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. UTD Hib by 24 months 95.1 96.1 3 Hep B by 24 months 98.8 96.1 1 Varicella by 24 months 97.5 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 98.8 92.2 84.0 70.6 64.2 57.3 58.0 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 8-1-C: Georgia Immunization Study and District 8-1 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 8-1: UTD by 24 months District 8-1: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 80 District 8-1, Georgia Immunization Study Report, p3 Table 8-1-F: UTD Immunization Rates by Demographic group, District 8-1, 2012 State Avg. UTD by 24 months % 8-1--UTD by 24 months (%) 8-1--UTD by end of d.c. (%) District 8-1 Sample (n=81) 84.5 88.9 96.3 Maternal Race/Ethnicity, UTD Immunization Rates by Demographic Group: In District 8-1, children of white, non-Hispanic mothers and black mothers were the largest demographic race/ethnicity groups in this District, and both had UTD rates by 24 months similar to the District rate as a whole and higher than the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 8-1-F). White, NonHispanic (n=28) White, Hispanic (n=3) Black (n=35) Unspecified, Hispanic (n=5) Asian (n=0) Multiracial (n=0) Maternal Education, Some College+ (n=34) 85.0 89.3 96.4 Children of mothers with some college education 89.3 100.0 100.0 were slightly less likely to be UTD at 24 months compared to those whose mothers had less 81.6 88.6 97.1 education. Children of unmarried mothers who were 86.5 100.0 100.0 the firstborn children were the most often UTD by 24 months (96.7%). 94.6 - - 90.2 - - Most children received government-assisted insurance at the time of birth, this group was slightly less likely to be UTD at 24 months than the 86.6 88.2 94.1 District as a whole (85.3% vs. 88.9%). HS Diploma/GED (n=30) 9th-11th grade (n=13) <9th grade (n=2) WIC Non-WIC (n=38) 82.9 90.0 96.7 District 8-1 children with two providers were slightly 82.9 92.3 100.0 more often UTD than those with just one provider (95.7% vs. 94.7%). 85.6 50.0 100.0 To varying degrees, most demographic-related disparities resolved by the end of data collection, 89.4 94.7 97.4 though some persisted (Table 8-1-F, column in WIC (n=43) Maternal Age <25 years (n=48) 25-34 years (n=28) 87.0 83.6 84.8 86.0 85.2 92.9 95.3 State Avg. 8-1--UTD 8-1--UTD UTD by 24 by 24 by end of months months d.c. 97.9 % (%) (%) 92.9 Number of Providers 35+ years (n=5) 86.7 100.0 Maternal Marital Status & Repeat Birth Combination 100.0 1 (n=38) 2 (n=23) 85.4 94.7 97.4 82.4 95.7 95.7 Married, First Birth (n=14) Unmarried, First Birth (n=30) 90.7 87.6 85.7 96.7 100.0 96.7 3+ (n=15) Child's Gender 85.0 69.2 100.0 Married, Repeat Birth (n=18) 82.5 83.3 88.9 Male (n=39) 84.6 84.6 92.3 Unmarried, Repeat Birth (n=19) Gestational Age 79.6 84.2 100.0 Female (n=42) Metro Residence 84.5 92.9 100.0 <37 weeks (n=8) 83.5 87.5 100.0 Metro (n=48) 83.9 89.9 97.9 37+ weeks (n=73) Provider Type 84.7 89.0 95.9 Non-metro (n=33) 86.4 87.9 93.9 Footnotes Public Sector Only (n=0) Private Sector Only (n=69) Both (n=7) Payment at Birth, Government Assist (n=61) Private Insurance (n=11) Other (n=1) Self Pay (n=1) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 94.2 57.1 85.3 100.0 100.0 100.0 97.1 100.0 95.1 100.0 100.0 100.0 81 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 8-1, Georgia Immunization Study Report, p4 italics). For example, children of mothers with some college education remained less UTD by the end of data collection (94.1%) than the rest of the group. The immunization rate of children with mothers 25-34 years of age remained unchanged at the end of data collection (92.9%). Children of married mothers with previous children had the lowest UTD rate by the end of data collection (88.9%) compared to children with mothers regardless of marital status or repeat births By the end of data collection children residing in nonmetro counties (see page 1 of District 8-1 Immunization Report) remained lower than those in metro counties with regard to UTD rate. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 8-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of mothers with some college education Children of mothers less than 25 years of age Children of married mothers with previous children Children receiving immunizations from 3+ providers Children residing in non-metro counties (see page 1 of District 8-1 Immunization Report) Table 8-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 8-1, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 81.0 83.2 79.5 84.7 94.8 3 Polio by 24 months 91.4 93.7 91.5 92.9 97.4 1 MMR by 24 months 86.2 90.5 85.5 88.2 96.1 UTD Hib by 24 months 89.7 96.8 92.3 92.9 96.1 3 Hepatitis B by 24 months 94.8 97.9 92.3 92.9 96.1 1 Varicella by 24 months 87.9 92.6 87.2 90.6 94.8 UTD PCV by 24 months 70.7 84.2 87.2 87.1 97.4 2 Rotavirus - - - 83.5 92.2 1 Influenza by 24 months - - - 60.0 61.0 2012 90.1 98.8 95.1 95.1 98.8 97.5 98.8 84.0 58.0 Immunization Rates by Vaccine Antigen: In District 81, the UTD immunization rate by 24 months for most vaccine antigens remained somewhat steady in District 8-1 from 2006 to 2010, with all antigens increasing in 2011. In 2012 half of the rates by antigen decreased slightly although rates remain high (Table 8-1-G). Among District 8-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP dropped the most and was lowest at 90.1%, down from 94.8% in 2011. Since first being ACIP-recommended in 2002, the UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 37.5% in 2005 (not shown) to 98.8% in 2012 in District 8-1. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District and County -level immunization campaigns. 82 District 8-2 2012 Georgia Immunization Study Report District 8-2 Data Collection Team Rebecca Snow, LPN District Immunization Coordinator Kelly Tillery Primary Data Collector County Sample Metro Baker 0 Metro Calhoun 1 Nonmetro Colquitt 26 Nonmetro Decatur 12 Nonmetro Dougherty 30 Metro Early 3 Nonmetro Grady 9 Nonmetro Lee 8 Metro Miller 3 Nonmetro Mitchell 14 Nonmetro Seminole 2 Nonmetro Terrell 4 Metro Thomas 15 Nonmetro Worth 5 Metro District 8-2 132 District UTD by 24 months 83.3% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Terrell Lee Calhoun Dougherty Worth Early Baker Miller Mitchell Colquitt Seminole Decatur Grady Thomas 83 District 8-2 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 8-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (83.3% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained lower than the state rate (88.6% vs. 93.6%) (Table 8-2-B). From 2011 to 2012: The District 8-2 UTD immunization rate by 24 months decreased by 0.7% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 8.5% from 2011 to 2012 (Figure 8-2-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 8-2-A: GIS Sampling Scheme, District 8-2, 2012 District 8-2 State (n) (n) Original Sample 143 2,973 Ineligible 4 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 139 2,835 7 246 Final Sample 132 2,589 Response Rate (%) 95.0% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 8-2-B: Immunization Summary by Series & Vaccine Antigen, District 8-2, 2012 District State 8-2 Average (%) (%) UTD immunization rate* by 24 months UTD immunization rate* by end of data collection 4 DTaP by 24 months 3 DTaP by 24 months 3 IPV by 24 months 83.3 84.5 88.6 93.6 86.4 87.0 93.9 97.0 93.2 96.0 1 MMR by 24 months 91.7 93.2 UTD Hib by 24 months 95.5 96.1 3 Hep B by 24 months 96.2 96.1 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 90.2 94.2 88.6 92.2 78.8 70.6 64.4 57.3 56.8 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 8-2-C: Georgia Immunization Study and District 8-2 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 8-2: UTD by 24 months District 8-2: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 84 District 8-2, Georgia Immunization Study Report, p3 Table 8-2-F: UTD Immunization Rates by Demographic group, District 8-2, 2012 State Avg. UTD by 24 months (%) 8-2--UTD by 24 months (%) 8-2--UTD by end of d.c. (%) District 8-2 Sample (n=132) Maternal Race/Ethnicity, 84.5 83.3 88.6 White, NonHispanic (n=55) White, Hispanic (n=0) 85.0 85.5 89.1 89.3 - - Black (n=64) 81.6 81.3 87.5 Unspecified, Hispanic (n=11) 86.5 81.8 90.9 Asian (n=0) 94.6 - - Multiracial (n=1) Maternal Education, 90.2 100.0 100.0 Some College+ (n=47) HS Diploma/GED (n=50) 86.6 87.2 91.5 82.9 84.0 88.0 9th-11th grade (n=26) 82.9 76.9 84.6 UTD Immunization Rates by Demographic Group: In District 8-2, the UTD by 24 months immunization rate for children of black mothers was lowest at 81.3%; this was the largest maternal race/ethnicity demographic group. Children of white, non-Hispanic mothers had a UTD by 24 months immunization rate slightly above the District as a whole (85.5% vs. 83.3%). The remaining race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 8-2-F). In District 8-2, higher maternal education was associated with UTD coverage rates by 24 months, although the sample size for the <9th grade maternal education group was too small to draw any conclusions (see Table 8-2-F). In terms of maternal age, children of mothers 25-34 years of age were the least often UTD by 24 months (77.6%). In terms of the maternal marital status and repeat births, children of mothers with previous children were less often UTD by 24 months than children of mothers without previous children (see Table 8-2-F). <9th grade (n=7) WIC Non-WIC (n=65) 85.6 71.4 85.7 Most children's birth costs were covered by government-assisted insurance and as such were more likely to be UTD at 24 months. The data also 89.4 87.7 89.2 support a medical home as children with two WIC (n=67) Maternal Age <25 years (n=73) 25-34 years (n=49) 87.0 83.6 84.8 83.6 87.7 77.6 88.1 State Avg. 8-2--UTD 8-2--UTD UTD by 24 by 24 by end of months months d.c. 91.8 (%) (%) (%) 83.7 Number of Providers 35+ years (n=10) 86.7 80.0 Maternal Marital Status & Repeat Birth Combination 90.0 1 (n=82) 2 (n=24) 85.4 84.2 87.8 82.4 75.0 91.7 Married, First Birth (n=15) 90.7 86.7 93.3 3+ (n=3) 85.0 100.0 100.0 Unmarried, First Birth (n=44) 87.6 93.2 95.5 Child's Gender Married, Repeat Birth (n=31) 82.5 80.7 83.9 Male (n=67) 84.6 82.1 91.0 Unmarried, Repeat Birth (n=42) Gestational Age 79.6 73.8 83.3 Female (n=65) 84.5 84.6 86.2 Metro Residence <37 weeks (n=14) 83.5 92.9 92.9 Metro (n=51) 83.9 76.5 80.4 37+ weeks (n=118) Provider Type 84.7 82.2 88.1 Non-metro (n=81) 86.4 87.7 93.8 Footnotes Public Sector Only (n=8) Private Sector Only (n=86) Both (n=15) Payment at Birth, Government Assist (n=49) Private Insurance (n=7) Other (n=8) Self Pay (n=10) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 62.5 84.9 80.0 87.8 71.4 100.0 80.0 75.0 89.5 93.3 91.8 85.7 100.0 90.0 85 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 8-2, Georgia Immunization Study Report, p4 providers were less likely to be UTD at 24 months than those with only one provider (75.0% vs. 84.2%). Children living in metro counties (see page 1 of District 8-2 Immunization Report) were less likely to be UTD at 24 months than those living in non-metro counties (76.5% vs. 87.7%). Several of these demographic-related disparities persisted through the end of data collection (Table 8-2 -F, column in italics). Children of mothers with previous children Children living in metro counties (see page 1 of District 8-2 Immunization Report) Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 8-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of less educated mothers Children who were born at a gestational age of 37+ weeks Children of mothers 25--34 years of age Table 8-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 8-2, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 71.7 78.2 78.4 86.8 86.0 3 Polio by 24 months 84.3 88.5 90.7 98.3 95.7 1 MMR by 24 months 85.0 88.5 87.1 92.1 94.6 UTD Hib by 24 months 91.3 89.7 82.7 90.4 93.6 3 Hepatitis B by 24 months 88.2 92.7 94.2 97.4 96.8 1 Varicella by 24 months 84.3 89.4 86.3 96.5 94.6 UTD PCV by 24 months 72.4 78.2 80.6 93.9 96.8 2 Rotavirus - - - 83.3 90.3 1 Influenza by 24 months - - - 62.3 58.1 2012 86.4 93.2 91.7 95.5 96.2 90.2 88.6 78.8 56.8 Immunization Rates by Vaccine Antigen: In District 82, the UTD immunization rate by 24 months for most vaccine antigens dropped from 2006 to 2008 in District 8-2, then peaked in 2010 or 2011. Only one antigen, Hib, peaked in 2012 (Table 8-2-G). Among District 8-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 86.4%, similar to 86.8% in 2010. The UTD immunization rate for PCV was second-lowest at 88.6%, down from 96.8% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine and the PCV vaccine could reasonably be the primary focus of District and County-level immunization campaigns, with Varicella and MMR close behind. 86 District 9-1 2012 Georgia Immunization Study Report District 9-1 Data Collection Team Beth Hausauer, RN, MSN District Immunization Coordinator Effingham County Sample Metro Bryan 8 Metro Camden 8 Nonmetro Chatham 104 Metro Effingham 14 Metro Glynn 25 Metro Liberty 15 Metro Long 3 Metro McIntosh 4 Metro District 9-1 181 District UTD by 24 months 80.7% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate 87 Bryan Chatham Liberty Long McIntosh Glynn Camden District 9-1 Georgia Immunization Study Report, p2 From 24 Months to End of Data Collection: In the District 9-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (80.7% vs. 84.5%). By the end of data collection, the District UTD immunization rate was similar to the state rate (93.4% vs. 93.6%) (Table 9-1-B). From 2011 to 2012: The District 9-1 UTD immunization rate by 24 months increased by 5.1% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 0.3% from 2011 to 2012 (Figure 9-1-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 9-1-A: GIS Sampling Scheme, District 9-1--2012 District 9-1 State (n) (n) Original Sample 216 2,973 Ineligible 11 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 205 2,835 24 246 Final Sample 181 2,589 Response Rate (%) 89.7% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 9-1-B: Immunization Summary by Series & Vaccine Antigen, District 9-1--2012 District State 9-1 Average (%) (%) UTD immunization rate* by 24 months 80.7 84.5 UTD immunization rate* by end of data collection 93.4 93.6 4 DTaP by 24 months 3 DTaP by 24 months 85.1 87.0 98.3 97.0 3 IPV by 24 months 98.3 96.0 1 MMR by 24 months 91.7 93.2 UTD Hib by 24 months 3 Hep B by 24 months 96.7 96.1 98.9 96.1 1 Varicella by 24 months 94.5 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 90.1 92.2 61.9 70.6 60.2 57.3 59.7 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 9-1-C: Georgia Immunization Study and District 9-1 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 9-1: UTD by 2 4 months Georgia: UTD by 24 months District 9-1: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 88 District 9-1, Georgia Immunization Study Report, p3 Table 9-1-F: UTD Immunization Rates by Demographic group, District 9-1--2012 State Avg. UTD by 24 months (%) 9-1--UTD by 24 months (%) 9-1--UTD by end of d.c. (%) District 9-1 Sample (n=181) 84.5 80.7 93.4 UTD Immunization Rates by Demographic Group: In District 9-1, the UTD by 24 months immunization rates for the two largest race/ethnicity groups children of white, non-Hispanic mothers and children of black mothers - were lower than the state average (83.6% and 78.8% respectively). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 9-1-F). Maternal Race/Ethnicity, White, NonHispanic (n=73) White, Hispanic (n=7) Black (n=80) Unspecified, Hispanic (n=6) Asian (n=2) Children of mothers with less than a 9th grade 85.0 83.6 90.4 education were the least often UTD by 24 months (75.0%) among the maternal education groups, but 89.3 71.4 100.0 were also the smallest group. 81.6 78.8 95.0 Children with mothers in the 35+ years age group 86.5 83.3 100.0 were the most likely to be UTD by 24 months 94.6 100.0 100.0 (88.2%). Multiracial (n=7) Maternal Education, Some College+ (n=80) HS Diploma/GED (n=52) 9th-11th grade (n=34) <9th grade (n=12) WIC Non-WIC (n=98) 90.2 71.4 100.0 Children of unmarried mothers with previous children were the least often UTD by 24 months of age (68.3%), followed by children of married 86.6 81.3 95.0 mothers with previous children (77.3%). 82.9 78.9 90.4 82.9 85.3 94.1 Children receiving immunizations from both public and private providers were more often UTD by 24 85.6 75.0 91.7 months than those receiving immunizations exclusively in the private sector (87.5% vs. 81.9%). In terms of payment at birth, District 9-1 children 89.4 85.7 93.9 whose birth costs were covered by private insurance WIC (n=83) Maternal Age <25 years (n=79) 25-34 years (n=85) 87.0 83.6 84.8 85.5 81.0 78.8 91.6 State Avg. 9-1--UTD 9-1--UTD UTD by 24 by 24 by end of months months d.c. 93.7 (%) (%) (%) 94.1 Number of Providers 35+ years (n=17) 86.7 88.2 Maternal Marital Status & Repeat Birth Combination 88.2 1 (n=108) 2 (n=38) 85.4 80.6 93.5 82.4 84.2 94.7 Married, First Birth (n=28) 90.7 96.4 100.0 3+ (n=9) 85.0 88.9 100.0 Unmarried, First Birth (n=49) 87.6 89.8 100.0 Child's Gender Married, Repeat Birth (n=44) 82.5 77.3 88.6 Male (n=90) 84.6 80.0 95.6 Unmarried, Repeat Birth (n=60) Gestational Age 79.6 68.3 88.3 Female (n=91) 84.5 81.3 91.2 Metro Residence <37 weeks (n=20) 83.5 80.0 95.0 Metro (n=171) 83.9 80.1 93.0 37+ weeks (n=161) Provider Type 84.7 80.8 93.2 Non-metro (n=10) 86.4 90.0 Footnotes 100.0 Public Sector Only (n=3) Private Sector Only (n=144) Both (n=8) Payment at Birth, Government Assist (n=124) Private Insurance (n=45) Other (n=3) Self Pay (n=4) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 66.7 81.9 87.5 81.5 86.7 33.3 75.0 100.0 93.8 100.0 91.9 97.8 100.0 100.0 89 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 9-1, Georgia Immunization Study Report, p4 were more often UTD by 24 months than children whose birth costs were covered by governmentassisted insurance (86.7% vs. 81.5%). (Methods, p 13), the District 9-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: The District 9-1 data did not support the importance of a medical home; children who had one provider (Number of Providers) were less often UTD by 24 months than those with two providers (80.6% vs. 84.2%). Children who resided in metro counties (see page 1 of District 9-1 Immunization Report) were less likely to be UTD at 24 months than those who resided in non-metro counties (80.1% vs. 90.0%). Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 9-1-F). Children of mothers with <9th grade education Children of mothers 25-34 years of age Children of unmarried mothers with previous children Children of mothers using government-assisted insurance for the birth event Children with only one provider Children residing in metro counties (see page 1 of District 9-1 Immunization Report) For example, children of mothers who had previous children remained less likely to be UTD by the end of data collection than children of mothers who did not have previous children. Children residing in metro counties remained less likely to be UTD by the end of data collection than those in non-metro counties. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data Table 9-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 9-1--2006-2012 4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months 2006 76.8 92.3 85.7 90.5 92.3 89.9 69.6 - 2007 77.1 87.9 86.4 87.1 87.1 86.4 77.9 - Immunization Rates by Vaccine Antigen: In District 91, the UTD immunization rate by 24 months for most vaccine antigens remained somewhat steady from 2006 to 2010, with all antigens increasing in 2011, and then again in 2012 (Table 9-1-G). Among District 9-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 85.1%, up from 83.8% in 2011. The UTD immunization rate for PCV was second-lowest at 2008 75.4 88.6 80.7 88.6 89.5 83.3 80.7 - 2010 74.3 92.1 87.9 87.1 91.4 90.0 89.3 65.7 57.9 2011 83.8 98.6 90.9 94.4 94.4 93.7 94.4 71.8 61.3 2012 85.1 98.3 91.7 96.7 98.9 94.5 90.1 61.9 60.2 90.1%, down from 94.4% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 90 District 9-2 2012 Georgia Immunization Study Report District 9-2 Data Collection Team Kay Davis, RN District Immunization Coordinator County Sample Metro Appling 13 Nonmetro Atkinson 1 Nonmetro Bacon 8 Nonmetro Brantley 0 Nonmetro Bulloch 21 Nonmetro Candler 3 Nonmetro Charlton 2 Nonmetro Clinch 2 Nonmetro Coffee 13 Nonmetro Evans 6 Nonmetro Jeff Davis 7 Nonmetro Pierce 5 Nonmetro Tattnall 6 Nonmetro Toombs 13 Nonmetro Ware 15 Nonmetro Wayne 13 Nonmetro District 9-2 128 District UTD by 24 months 84.4% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Bulloch Candler Toombs Evans Tattnall Jeff Davis Appling Coffee Atkinson Bacon Wayne Pierce Ware Brantley Clinch Charlton 91 District 9-2 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 9-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was similar to the state rate (84.4% vs. 84.5%). At the end of data collection, the District UTD immunization rate remained similar to the state rate (93.8% vs. 93.6%) (Table 9-2-B). From 2011 to 2012: The District 9-2 UTD immunization rate by 24 months increased by 0.7% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 1.1% from 2011 to 2012 (Figure 9-2-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 9-2-A: GIS Sampling Scheme, District 9-2, 2012 District 9-2 State (n) (n) Original Sample 140 2,973 Ineligible 6 130 Refused to Participate 0 8 Eligible Sample Unable to Locate 134 2,835 6 246 Final Sample 128 2,589 Response Rate (%) 95.5% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 9-2-B: Immunization Summary by Series & Vaccine Antigen, District 9-2, 2012 District State 9-2 Average (%) (%) UTD immunization rate* by 24 months 84.4 84.5 UTD immunization rate* by end of data collection 93.8 93.6 4 DTaP by 24 months 3 DTaP by 24 months 83.6 87.0 96.1 97.0 3 IPV by 24 months 95.3 96.0 1 MMR by 24 months 94.5 93.2 UTD Hib by 24 months 3 Hep B by 24 months 96.1 96.1 96.9 96.1 1 Varicella by 24 months 93.8 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 89.1 92.2 64.1 70.6 60.9 57.3 50.8 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. 100% Figure 9-2-C: Georgia Immunization Study and District 9-2 Immunization Rates, 2000-2012 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 8-1: UTD by 24 months District 8-1: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 92 District 9-2, Georgia Immunization Study Report, p3 Table 9-2-F: UTD Immunization Rates by Demographic group, District 9-2, 2012 State Avg. UTD by 24 months (%) 9-2--UTD by 24 months (%) 9-2--UTD by end of d.c. (%) District 9-2 Sample (n=128) 84.5 84.4 93.8 UTD Immunization Rates by Demographic Group: In District 9-2, the UTD by 24 months immunization rate for children of white, non-Hispanic mothers was higher than that for children of black mothers (87.9% vs. 74.4%) - the two largest racial/ethnic groups in District 9-2. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 9-2-F). Maternal Race/Ethnicity, White, NonHispanic (n=66) White, Hispanic (n=5) Black (n=43) Unspecified, Hispanic (n=9) Asian (n=0) Multiracial (n=3) Maternal Education, Maternal education was associated with higher UTD 85.0 87.9 95.5 immunization rates by 24 months, with the exception of children whose mothers had less than 89.3 100.0 100.0 a 9th grade education (see Table 9-2-F). 81.6 74.4 88.4 86.5 100.0 100.0 In terms of maternal age, children of mothers 25-34 years of age were least often UTD by 24 months of 94.6 - - age (81.6%). Children of mothers who had no 90.2 66.7 100.0 previous children were more often UTD by 24 months than those with previous children, regardless of marital status (see Table 9-2-F). Some College+ (n=40) HS Diploma/GED (n=50) 9th-11th grade (n=30) <9th grade (n=6) WIC Non-WIC (n=62) 86.6 90.0 95.0 Children receiving immunizations from both public 82.9 82.0 94.0 and private providers were the less often UTD by 24 82.9 80.0 93.3 months than those receiving immunizations exclusively in the private sector (76.9% vs. 86.8%). 85.6 83.3 83.3 District 9-2 children whose birth costs were covered by government-assisted insurance were less often 89.4 85.5 93.5 WIC (n=66) Maternal Age <25 years (n=70) 25-34 years (n=49) 87.0 86.4 93.9 83.6 85.7 94.3 State Avg. UTD by 24 months (%) 9-2--UTD by 24 months (%) 9-2--UTD by end of d.c. (%) 84.8 81.6 93.9 Number of Providers 35+ years (n=9) 86.7 88.9 Maternal Marital Status & Repeat Birth Combination 88.9 1 (n=82) 2 (n=35) 85.4 85.4 92.7 82.4 82.9 97.1 Married, First Birth (n=23) Unmarried, First Birth (n=26) 90.7 87.6 91.3 92.3 100.0 92.3 3+ (n=7) Child's Gender 85.0 100.0 100.0 Married, Repeat Birth (n=36) 82.5 75.0 91.7 Male (n=62) 84.6 83.9 96.8 Unmarried, Repeat Birth (n=43) Gestational Age 79.6 83.7 93.0 Female (n=66) 84.5 84.9 90.9 Metro Residence <37 weeks (n=20) 83.5 80.0 95.0 Metro (n=1) 83.9 100.0 100.0 37+ weeks (n=108) Provider Type 84.7 85.2 93.5 Non-metro (n=127) 86.4 84.3 93.7 Footnotes Public Sector Only (n=7) Private Sector Only (n=91) Both (n=26) Payment at Birth, Government Assist (n=90) Private Insurance (n=23) Other (n=0) Self Pay (n=11) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 85.7 86.8 76.9 83.3 87.0 90.9 100.0 92.3 100.0 94.4 95.7 90.9 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. 93 District 9-2, Georgia Immunization Study Report, p4 UTD by 24 months than children whose birth costs were covered by private insurance (83.3% vs. 87.0%). Children of mothers without college education Children who received their immunizations from one provider were slightly more likely to be UTD at 24 months than those who had two providers (85.4% vs. 82.9%). Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 9-2-F, column in italics). For example, children of black mothers remained less often UTD by the end of the data collection period than children of white, non-Hispanic mothers (88.4% vs. 95.5%). Children of mothers between 25-34 years of age Children of mothers with previous children Children immunized in both the private and public sectors Children whose birth costs were covered by government-assisted insurance Children who received immunizations from two providers vs. a single provider Children whose birth costs were covered by government-assisted insurance remained less often UTD than children whose birth costs were covered by private insurance (94.4% vs. 95.7%). Male children were more often UTD by the end of data collection than female children (96.8% vs. 90.9%) which was a reversal of the trend at 24 months. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 9-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Table 9-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 9-2, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 73.2 81.4 79.5 75.7 85.6 3 Polio by 24 months 91.1 91.5 91.6 94.4 95.5 1 MMR by 24 months 83.7 87.6 88.0 86.9 94.6 UTD Hib by 24 months 84.6 88.4 88.0 82.2 92.8 3 Hepatitis B by 24 months 89.4 93.0 95.2 92.5 95.5 1 Varicella by 24 months 86.2 90.7 91.6 88.8 95.5 UTD PCV by 24 months 68.3 76.7 85.5 86.0 96.4 2 Rotavirus - - - 73.8 81.1 1 Influenza by 24 months - - - 51.4 49.6 2012 83.6 95.3 94.5 96.1 96.9 93.8 89.1 64.1 60.9 Immunization Rates by Vaccine Antigen: In District 92, the UTD immunization rates by 24 months for most vaccine antigens fluctuated from 2006 to 2010; with all vaccine antigens increased in 2011, and several decreased in 2012 (Table 9-2-G). Among District 9-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 83.6%, down from 85.6% in 2011. The UTD immunization rate for PCV was second-lowest at 89.1%, down from 96.4% in 2011. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns. 94 District 10-0 2012 Georgia Immunization Study Report District 10 Data Collection Team Dionne Hansey Immunization Administrative Specialist County Sample Metro Barrow 31 Metro Clarke 48 Metro Elbert 9 Nonmetro Greene 3 Nonmetro Jackson 22 Nonmetro Madison 10 Metro Morgan 7 Nonmetro Oconee 9 Metro Oglethrope 1 Metro Walton 27 Metro District 10 167 District UTD by 24 months 85.0% Immunization Rate State of Georgia 2,589 State UTD by 24 months 84.5% Immunization Rate Jackson Madison Elbert Barrow Walton Clarke Oconee Oglethorpe Morgan Greene 95 District 10-0 Georgia Immunization Study Report, p2 From 24 months to End of Data Collection: In the District 10 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was similar to the state rate (85.0% vs. 84.5%). By the end of data collection, the District UTD immunization rate was lower than the state rate (90.4% vs. 93.6%) (Table 10B). From 2011 to 2012: The District 10 UTD immunization rate by 24 months increased by 7.9% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 2.7% from 2011 to 2012 (Figure 10-C). Sample population demographics for this District and their effect on up-to-date (UTD) immunization rates are discussed on the following pages. Table 10-0-A: GIS Sampling Scheme, District 10, 2012 District 10 (n) State (n) Original Sample 180 2,973 Ineligible 9 130 Refused to Participate 1 8 Eligible Sample Unable to Locate 170 2,835 3 246 Final Sample 167 2,589 Response Rate (%) 98.2% 92.3% Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian. Table 10-0-B: Immunization Summary by Series & Vaccine Antigen, District 10, 2012 District State 10 Average (%) (%) UTD immunization rate* by 24 months 85.0 84.5 UTD immunization rate* by end of data collection 90.4 93.6 4 DTaP by 24 months 3 DTaP by 24 months 89.2 87.0 98.8 97.0 3 IPV by 24 months 95.8 96.0 1 MMR by 24 months 94.6 93.2 UTD Hib by 24 months 3 Hep B by 24 months 98.2 96.1 95.2 96.1 1 Varicella by 24 months 95.8 94.2 UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 97.0 92.2 79.0 70.6 55.1 57.3 50.3 57.1 This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of District staff to reach the children originally listed as incomplete in their District. * This rate includes children up-to-date by ACIP-recommended catch-up schedule. Figure 10-0-C: Georgia Immunization Study and District 10-0 Immunization Rates, 2000-2012 100% 90% 80% 70% 60% 50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012 District 10: UTD by 24 months District 10: UTD by end of data collection Georgia: UTD by 24 months Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy. 96 District 10, Georgia Immunization Study Report, p3 Table 10-0-F: UTD Immunization Rates by Demographic group, District 10, 2012 State Avg. UTD by 24 months (%) 10--UTD by 24 months (%) 10--UTD by end of d.c. (%) District 10 Sample (n=167) 84.5 85.0 90.4 UTD Immunization Rates by Demographic Group: In District 10-0, children of white, non-Hispanic mothers and black mothers had similar UTD immunization rates by 24 months (83.5% and 81.0%, respectively); these were the largest demographic groups in District 10-0. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 10-0-F). Maternal Race/Ethnicity, White, NonHispanic (n=91) White, Hispanic (n=13) Black (n=42) Unspecified, Hispanic (n=11) Asian (n=3) Multiracial (n=2) Higher maternal education was not associated with 85.0 83.5 87.9 UTD coverage rates, although the sample size for 89.3 100.0 100.0 the <9th grade maternal education group was too small to draw any conclusions (see Table 10-0-F). 81.6 81.0 92.9 86.5 90.9 90.9 Children of mothers 35+ years of age were the most often UTD by 24 months (94.1%). Children of 94.6 100.0 100.0 unmarried mothers with previous children were 90.2 100.0 100.0 least often UTD by 24 months (80.5%). Maternal Education, Some College+ (n=72) HS Diploma/GED (n=44) 9th-11th grade (n=40) In terms of payment at birth, District 10 children 86.6 84.7 88.9 whose birth costs were covered by governmentassisted insurance were UTD by 24 months as often 82.9 79.6 86.4 as children whose birth was covered by private 82.9 90.0 95.0 insurance (85.4% vs. 85.4%). <9th grade (n=4) WIC Non-WIC (n=103) 85.6 100.0 100.0 Interestingly, children who received their vaccinations from more than one provider were more often UTD by 24 months than children with 89.4 91.3 92.2 only one provider (92.6% vs. 79.7%). WIC (n=64) Maternal Age <25 years (n=71) 25-34 years (n=79) 87.0 83.6 84.8 85.9 84.5 83.5 89.1 State Avg. 10--UTD 10--UTD UTD by 24 by 24 by end of months months d.c. 91.6 (%) (%) (%) 88.6 Number of Providers 35+ years (n=17) 86.7 94.1 Maternal Marital Status & Repeat Birth Combination 94.1 1 (n=69) 2 (n=27) 85.4 79.7 88.4 82.4 92.6 96.3 Married, First Birth (n=40) Unmarried, First Birth (n=36) 90.7 87.6 87.5 86.1 92.5 3+ (n=6) 94.4 Child's Gender 85.0 100.0 100.0 Married, Repeat Birth (n=49) Unmarried, Repeat Birth (n=41) Gestational Age 82.5 85.7 87.8 Male (n=85) 84.6 84.7 92.9 79.6 80.5 87.8 Female (n=82) 84.5 85.4 87.8 Metro Residence <37 weeks (n=19) 83.5 89.5 89.5 Metro (n=125) 83.9 86.4 90.4 37+ weeks (n=148) Provider Type 84.7 84.5 90.5 Non-metro (n=42) 86.4 81.0 90.5 Footnotes Public Sector Only (n=2) Private Sector Only (n=97) Both (n=7) Payment at Birth, Government Assist (n=89) Private Insurance (n=41) Other (n=0) Self Pay (n=11) 73.1 86.0 73.8 82.1 88.2 89.2 87.2 50.0 83.5 85.7 85.4 85.4 90.9 100.0 88.7 100.0 91.0 90.2 100.0 97 "d.c." is an abbreviation for "data collection" Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the sample size numbers for this variable may not add up to the total District sample size because the information was missing in some cases. Please see Appendix C for additional information regarding the methodology in obtaining this variable. * Indicates that there were less than 10 children in this demographic category. District 10, Georgia Immunization Study Report, p4 Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 10-0-F, column in italics). Children with more than only one provider Children who reside in non-metro counties (see page 1 of District 10-0 Immunization Report) For example, children of mothers 35+ years of age remained the most UTD among the maternal age categories (94.1%). Children of mothers who had previous children remained less often UTD by the end of data collection than those with no previous children. Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), the District 10 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age: Children of mothers with a high school diploma or GED Children of mothers 25-34 years of age Children of unmarried mothers with previous children Table 10-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 10, 2006-2012 2006 2007 2008 2010 2011 4 DTaP by 24 months 86.1 80.8 78.0 91.6 84.9 3 Polio by 24 months 93.1 86.5 87.1 97.7 96.0 1 MMR by 24 months 91.7 88.5 84.1 95.4 89.9 UTD Hib by 24 months 95.8 86.5 87.1 95.4 95.0 3 Hepatitis B by 24 months 93.1 88.5 87.9 97.0 95.0 1 Varicella by 24 months 91.7 89.4 85.6 97.0 93.9 UTD PCV by 24 months 76.4 79.8 84.1 97.7 95.0 2 Rotavirus - - - 74.8 82.8 1 Influenza by 24 months - - - 59.5 53.5 2012 89.2 95.8 94.6 98.2 95.2 95.8 97.0 79.0 50.3 Immunization Rates by Vaccine Antigen: In District 10, the UTD immunization rates by 24 months for most vaccine antigens were at their highest in 2010, decreased across the board in 2011, and improved again in 2012(Table 10-0-G). Among District 10-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was the lowest at 89.2%, up from 84.9% in 2011. The UTD immunization rate for MMR was the second-lowest at 94.6%, up from 89.9% in 2011. Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 37.1% in 2005 (not shown) to 97.0% in 2012. Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District and County -level immunization campaigns. 98 99 100 Appendix Georgia Immunization Study, 2012 i ii Appendix A: Margins of Error, p1 Appendix Table A-1: Margins of Error for UTD Immunization Rates by 24 months, Georgia, 2012 District Final Margin of Sample (n) Imm Rate 1-Imm Rate Error 95% Confidence Intervals 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2-0 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 Gwinnett, Newton, Rockdale 3-5 DeKalb 4-0 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6-0 East Central (Augusta) 7-0 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10-0 Northeast (Athens) Georgia 127 143 126 140 194 124 195 150 151 77 158 159 156 81 132 181 128 167 2,589 92.9% 87.4% 84.1% 82.9% 77.3% 83.9% 81.5% 87.3% 88.1% 77.9% 85.4% 82.4% 91.0% 88.9% 83.3% 80.7% 84.4% 85.0% 84.5% 7.1% 12.6% 15.9% 17.1% 22.7% 16.1% 18.5% 12.7% 11.9% 22.1% 14.6% 17.6% 9.0% 11.1% 16.7% 19.3% 15.6% 15.0% 15.5% 4.5% 5.4% 6.4% 6.2% 5.9% 6.5% 5.5% 5.3% 5.2% 9.3% 5.5% 5.9% 4.5% 6.8% 6.4% 5.7% 6.3% 5.4% 1.4% 88.4% - 97.4% 82% - 92.8% 77.7% - 90.5% 76.7% - 89.1% 71.4% - 83.2% 77.4% - 90.4% 76.0% - 87.0% 82.% - 92.6% 82.9% - 93.3% 68.6% - 87.2% 79.9% - 90.9% 76.5% - 88.3% 86.5% - 95.5% 82.1% - 95.7% 76.9% - 89.7% 75.0% - 86.4% 78.1% - 90.7% 79.6% - 90.4% 83.1% - 85.9% iii Appendix A: Margins of Error, p2 Appendix Table A-2: Margins of Error for UTD Immunization Rates by End of Six-Month Data Collection, Georgia, 2012 District Final Margin of Sample (n) Imm Rate 1-Imm Rate Error 95% Confidence Intervals 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2-0 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 Gwinnett, Newton, Rockdale 3-5 DeKalb 4-0 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6-0 East Central (Augusta) 7-0 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10-0 Northeast (Athens) Georgia 127 143 126 140 194 124 195 150 151 77 158 159 156 81 132 181 128 167 2589 96.9% 95.1% 94.4% 95.0% 84.0% 95.2% 91.8% 98.0% 96.7% 93.5% 93.7% 93.7% 98.7% 96.3% 88.6% 93.4% 93.8% 90.4% 93.6% 3.1% 4.9% 5.6% 5.0% 16.0% 4.8% 8.2% 2.0% 3.3% 6.5% 6.3% 6.3% 1.3% 3.7% 11.4% 6.6% 6.2% 9.6% 6.4% 3.0% 3.5% 4.0% 3.6% 5.2% 3.8% 3.9% 2.2% 2.8% 5.5% 3.8% 3.8% 1.8% 4.1% 5.4% 3.6% 4.2% 4.5% 0.9% 93.9% - 99.9% 91.6% - 98.6% 90.4% - 98.4% 91.4% - 98.6% 78.8% - 89.2% 91.4% - 99.0% 87.9% - 95.7% 95.8% - 100.0% 93.9% - 99.5% 88.0% - 99.0% 89.9% - 97.5% 89.9% - 97.5% 96.9% - 100.0% 92.2% - 100.0% 83.2% - 94.0% 89.8% - 97.0% 89.6% - 98.0% 85.9% - 94.9% 92.7% - 94.5% iv Appendix B: Description of Demographic Variables, p1 Variable Maternal Race Maternal Ethnicity Maternal Education Maternal Age Maternal Marital Status Repeat Birth Gestational Age <37 weeks Payment at Birth Child's Gender Provider Type Number of Providers How Often Missing for State Sample (%) 12.3% 5.1% 4.5% 0% 0.2% 0.1% 0% 11.7% 0% 24.6% 24.6% Source Additional Information Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records Electronic Birth Records GRITS/Data Collectors GRITS/Data Collectors Was combined with maternal ethnicity variable to form race/ethnicity category. Only used in combination with white race and undefined race because the statewide sample had fewer than 10 children for whom maternal race was defined, not "white", with Hispanic ethnicity. Additional coding not needed; standard measure in GA Electronic Birth Records. Originally coded as number of days. Maternal age break-down chosen based on HEDIS measures Additional coding not needed; standard measure in GA Electronic Birth Records. See below for more information about combination with repeat birth variable. Additional coding not needed; standard measure in GA Electronic Birth Records. Combined with maternal marital status to limit possible effect modification or confounding between the two variables. Additional coding not needed; standard measure in GA Electronic Birth Records. Additional coding was required to create "Government Assist" classification, combining all different codes involving Medicaid, Medicare, and Georgia Better Health Care Additional coding not needed; standard measure in GA Electronic Birth Records. For each administered vaccine, the provider was assessed as either private, public or unknown. If a child only received immunizations from a public health department, they were classified as "public only". If a child received immunizations exclusively from (a) private provider/s, they were classified as "private only". If they received immunizations from a mixture, they were classified as "both" For each administered vaccine, the provider was researched. For records where the same provider administered all vaccines, the child was classified as having "1" provider. For two different providers, the child would have "2" providers. The number of providers was limited to 3. v Appendix B: Description of Demographic Variables, p2 Variable WIC Enrollment Metro Residence Missing for State Sample (%) Source Additional Information N/A 0.1% WIC Program Yearly cumulative lists of enrolled children were used to match children from the study sample to the enrollment list using names and dates of birth. The duration of enrollment was not calculated, so the children classified as "WIC enrolled" could have been enrolled for a short amount of time or for their entire lives. 2003 Rural-Urban R-U Continuum Code was assigned by Continuum Codes, child's residential county and later Economic Research categorized as metro or non-metro using Service guide in below table. 2003 Rural-Urban Continuum Codes* Metro Counties 1 Counties in metro areas of 1 million population or more 2 Counties in metro areas of 250,000 to 1 million population 3 Counties in metro areas of fewer than 250,000 population Non-Metro Counties 4 Urban population of 20,000 or more, adjacent to metro area 5 Urban population of 20,000 or more, not adjacent to metro area 6 2,500 to 19,999, adjacent to metro area 7 2,500 to 19,999, not adjacent to metro area 8 Completely rural or less than 2,500 population, adjacent to metro area 9 Completely rural or less than 2,500 population, not adjacent to metro area * This coding scheme was originated in 1975 by David L. Brown, Fred K. Hines, and John M. Zimmer, then of the Economic Research Service, for a report Social and Economic Characteristics of the Population in Metro and Nonmetro Counties: 1970. It was updated after both the 1980 and 1990 censuses, with a somewhat more restrictive procedure for determining metro adjacency. The versions based on the 1970, 1980, and 1990 Censuses are all found on this ERS website: http://www.ers.usda.gov/briefing/rurality/ruralurbcon/ vi Appendix C: Reasons for Incomplete Immunization History Appendix Table C: Frequency of Reasons for Incomplete Immunizations by End of Data Collection, Georgia, 2012 A.Religious Exemption B.Medical Exemption C.Temporary Vaccine Shortage D.Parental Refuses to Vaccinate* E.Parental Chooses to use Delayed Schedule F.Physician Chooses to use Delayed Schedule G.Missed Appointments/Convenience Issue H.Unable to Locate Parent and/or Physician I.Other District Sample A B C D E F G H I 1-1 Northwest (Rome) 127 0 0 0 1 3 0 0 0 0 1-2 North Georgia (Dalton) 143 0 0 0 2 1 0 3 0 0 2-0 North (Gainesville) 126 2 0 0 2 0 0 3 0 0 3-1 Cobb-Douglas 140 2 0 0 3 0 0 2 0 1 3-2 Fulton 194 0 0 0 0 21 3 0 0 6 3-3 Clayton 124 0 0 0 0 2 0 1 0 3 3-4 Gwinnett, Newton, Rockdale 195 0 1 0 6 3 2 0 0 3 3-5 DeKalb 150 0 0 0 0 0 0 1 0 0 4-0 LaGrange 151 0 0 0 0 2 0 1 0 1 5-1 South Central (Dublin) 77 0 0 0 1 2 0 0 0 0 5-2 North Central (Macon) 158 1 1 0 0 0 0 6 0 2 6-0 East Central (Augusta) 159 0 0 2 0 1 1 6 0 0 7-0 West Central (Columbus) 156 0 0 0 0 1 0 0 0 0 8-1 South (Valdosta) 81 0 0 0 0 2 0 0 0 1 8-2 Southwest (Albany) 132 0 0 0 1 4 0 9 0 1 9-1 Coastal (Savannah) 181 1 1 0 2 7 1 0 0 1 9-2 Southeast (Waycross) 128 1 0 0 0 4 1 2 0 0 10-0 Northeast (Athens) 167 0 0 0 2 11 1 1 0 0 Georgia 2,589 7 3 2 20 64 9 35 0 19 *Child was classified as "Parent Refusal to Vaccinate" if a parent refused one or more vaccine series. Total 4 6 7 8 30 6 15 1 4 3 10 10 1 3 15 13 8 15 159 vii viii Table 1-1-D: Sample Population Demographics, District 1-1, 2012 Notable Demographic Findings: The District 1-1 Final Sample District 1-1 Final % n=127 State Final Sample % n=2,589 proportion of children whose mothers were classified as white, non-Hispanic was greater for the District sample than for the overall state sample (70.9% vs. 40.9%), while the Maternal Race/Ethnicity, proportion of children with mothers classified White, NonHispanic (n=90) White, Hispanic (n=5) 70.9 40.9 as Black was much lower (9.5% vs. 37.0%) (Table 1-1-D). 3.9 4.3 Black (n=12) Unspecified, Hispanic (n=2) Asian (n=0) Multiracial (n=2) 9.5 37.0 A similar proportion of children were enrolled 1.6 8.9 in WIC in the District sample compared to the proportion enrolled in WIC in the overall state 0 2.2 sample (46.5% vs. 45.1%). 1.6 1.6 Maternal Education, Some College+ (n=53) HS Diploma/GED (n=41) 9th-11th grade (n=23) <9th grade (n=9) The District 1-1 sample had a greater proportion of children with married mothers 41.7 41.6 when compared to the state sample (64.6% vs. 32.3 30.1 49.0%) as well as a greater proportion of 18.1 17.7 children who were seen by only one provider (63.8% vs. 51.2%). 7.1 6.2 WIC Non-WIC (n=68) WIC (n=59) Metro Residence Metro (n=99) The District 1-1 sample had a smaller 53.5 54.9 proportion of children whose payment for birth cost was through government assistance 46.5 45.1 compared to the state sample (41.7% vs. 50.4%) while the proportion covered by private 78.0 76.1 insurance was greater (36.2% vs. 27.5%) Non-metro (n=28) Maternal Marital Status Married (n=82) 22.0 23.8 Other demographic measures for this District were similar to findings for the state sample as a whole. 64.6 49.0 Unmarried (n=45) 35.4 50.8 Repeat Birth First Child (n=65) Repeat Birth (n=62) Gestational Age 51.2 42.6 48.8 57.3 Child's Gender District State Final 1-1 Final (%) Sample (%) <37 weeks (n=23) 18.1 11.4 Male (n=60) 47.2 50.3 37+ weeks (n=104) 81.9 88.6 Female (n=67) 52.8 49.7 Provider Type, Number of Providers, Public Sector Only (n=1) 0.8 2.0 1 (n=81) 63.8 51.2 Private Sector Only (n=107) 84.3 66.7 2 (n=28) 22.1 17.2 Both (n=9) 7.1 6.6 3+ (n=8) 6.3 7.0 Payment at Birth Maternal Age Government Assist (n=)53 41.7 50.4 <25 years (n=63) 49.6 41.3 Private Insurance (n=46) 36.2 27.5 25-34 years (n=53) 41.7 47.1 Other (n=12) 9.5 5.0 35+ years (n=11) 8.7 11.6 Self Pay (n=5) 3.9 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. ix Table 1-2-D: Sample Population Demographics, District 1-2,2012 District 1-2 State Final Final % Sample % District 1-2 Final Sample Maternal Race/Ethnicity, n=143 n=2,589 White, NonHispanic (n=93) 65.0 40.9 Notable Demographic Findings: The proportion of children with mothers classified as white, non-Hispanic was greater for the District sample than for the overall state sample (65.0% vs. 40.9%), while the proportion of children with mothers classified as Black was much lower (3.5% vs. 37.0%) (Table 1-2-D). White, Hispanic (n=2) Black (n=5) Unspecified, Hispanic (n=26) 1.4 4.3 For the District 1-2 sample, the proportion of 3.5 37.0 children enrolled in WIC was less than that of 18.2 8.9 the state sample (36.4% vs. 45.1%). Asian (n=2) Multiracial (n=0) Maternal Education, Some College+ (n=49) HS Diploma/GED (n=38) 9th-11th grade (n=25) <9th grade (n=19) WIC Non-WIC (n=91) WIC (n=52) Metro Residence, 1.4 2.2 A smaller proportion of children in the District 0 1.6 1-2 sample had mothers with some college education compared to the state sample (34.3% vs. 41.6%). The District sample had a 34.3 41.6 larger proportion of children whose mothers 26.6 30.1 were married (62.2% vs. 49.0%), as well as a 17.5 17.7 larger proportion of children whose birth costs were covered by private insurance (33.6% vs. 13.3 6.2 27.5%). 63.6 54.9 For the District 1-2 sample, a larger proportion of children were born at a gestational age of 36.4 45.1 37+ weeks when compared to the overall state sample (93.7% vs. 88.6%). Metro (n=121) Non-metro (n=20) Maternal Marital Status , 84.6 76.1 Other demographic measures for this District 14.0 23.8 were similar to findings for the state sample as a whole. Married (n=89) 62.2 49.0 Unmarried (n=51) 35.7 50.8 Repeat Birth, First Child (n=63) Repeat Birth (n=78) 44.1 42.6 54.6 57.3 District State Final 1-2 Final (%) Sample (%) Gestational Age Child's Gender <37 weeks (n=9) 6.3 11.4 Male (n=77) 53.9 50.3 37+ weeks (n=134) 93.7 88.6 Female (n=66) 46.2 49.7 Provider Type, Number of Providers, Public Sector Only (n=3) 2.1 2.0 1 (n=83) 58 51.2 Private Sector Only (n=118) 82.5 66.7 2 (n=30) 21.0 17.2 Both (n=12) 8.4 6.6 3+ (n=20) 14.0 7.0 Payment at Birth, Maternal Age Government Assist (n=50) 35.0 50.4 <25 years (n=55) 38.5 41.3 Private Insurance (n=48) 33.6 27.5 25-34 years (n=68) 47.6 47.1 Other (n=8) 5.6 5.0 35+ years (n=20) 14.0 11.6 Self Pay (n=16) 11.2 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. x Table 2-0-D: Sample Population Demographics, District 2-0, 2012 District State Final 2-0 Final % Sample % District 2-0 Final Sample n=126 n=2,589 Maternal Race/Ethnicity, Notable Demographic Findings: The proportion of children wh%osoef Fminoatlhers%wofeIrneitial classified as white, non-HiSsapmanpliec was gSraemaptleer for the District sample than for the overall state sample as a whole(59.6% vs. 40.9%) (Table 2-0-D). White, NonHispanic (n=75) White, Hispanic (n=21) Black (n=5) Unspecified, Hispanic (n=7) Asian (n=6) Multiracial (n=0) Maternal Education, Some College+ (n=46) HS Diploma/GED (n=41) 9th-11th grade (n=25) <9th grade (n=9) WIC Non-WIC (n=69) WIC (n=57) 59.6 40.9 The proportion of children enrolled in WIC 16.7 4.3 was similar to the state sample (45.2% vs. 4.0 37.0 45.1%). 5.6 8.9 4.8 2.2 The District sample had a smaller proportion of children whose mothers had some college 0 1.6 education than the state sample (36.5% vs. 41.6%). There was a larger proportion of 36.5 41.6 male children in the District sample than the state sample (58.7% vs. 50.3%) 32.5 30.1 19.8 17.7 There was a larger proportion of children of 7.1 6.2 married mothers than the state sample (65.1% vs. 49.0%). 54.8 54.9 Other demographic measures for this District were similar to findings for the state sample. 45.2 45.1 Metro Residence Metro (n=84) 66.7 76.1 Non-metro (n=42) Maternal Marital Status 33.3 23.8 Married (n=82) 65.1 49.0 Unmarried (n=44) 34.9 50.8 Repeat Birth First Child (n=56) Repeat Birth (n=70) Gestational Age 44.4 42.6 55.6 57.3 Child's Gender District 2-0 Final (%) State Final Sample (%) <37 weeks (n=15) 11.9 11.4 Male (n=74) 58.7 50.3 37+ weeks (n=111) 88.1 88.6 Female (n=52) 41.3 49.7 Provider Type Number of Providers Public Sector Only (n=3) 2.4 2.0 1 (n=54) 43.0 51.2 Private Sector Only (n=67) 53.2 66.7 2 (n=10) 7.9 17.2 Both (n=3) 2.4 6.6 3+ (n=9) 7.2 7.0 Payment at Birth, Maternal Age Government Assist (n=60) 47.6 50.4 <25 years (n=50) 40.0 41.3 Private Insurance (n=39) 31.0 27.5 25-34 years (n=58) 46.0 47.1 Other (n=12) 9.5 5.0 35+ years (n=18) 14.3 11.6 Self Pay (n=2) 1.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xi Table 3-1-D: Sample Population Demographics, District 3-1, 2012 District State Final 3-1 Final % Sample % District 3-1 Final Sample Maternal Race/Ethnicity, n=140 n=2,589 White, NonHispanic (n=58) 41.4 40.9 White, Hispanic (n=14) 10.0 4.3 Black (n=44) 31.4 37.0 Unspecified, Hispanic (n=8) 5.7 8.9 Asian (n=3) 2.1 2.2 Multiracial (n=4) Maternal Education, 2.9 1.6 Some College+ (n=78) HS Diploma/GED (n=36) 55.7 41.6 25.7 30.1 9th-11th grade (n=17) 12.1 17.7 Notable Demographic Findings: The maternal race/ethnicity breakdow%nowf aFsinsailmila%r bofeItnwiteiael n the District sample and thSeamopvleerall staStaemspalemple (Table 3-1-D). A larger proportion of children in the District 3 -1 sample had mothers with some college education than the state sample (55.7% vs. 41.6%), as well as a larger proportion with married mothers (63.6% vs. 49.0%). The District sample had a smaller proportion of children enrolled in WIC than the state sample overall (35.7% vs. 45.1%) The District sample had a higher proportion of mothers who used private insurance as their payment for birth costs than the state sample (35.0%vs. 27.5%) <9th grade (n=5) WIC 3.6 6.2 Provider type and number of providers was not available for the District 3-1 sample. Non-WIC (n=90) WIC (n=50) Metro Residence 64.3 54.9 Other demographic measures for this District 35.7 45.1 were similar to findings for the state sample as a whole. Metro (n=140) 100.0 76.1 Non-metro (n=0) Maternal Marital Status 0 23.8 Married (n=89) 63.6 49.0 Unmarried (n=51) Repeat Birth 36.4 50.8 First Child (n=59) Repeat Birth (n=81) Gestational Age 42.1 42.6 57.9 57.3 Child's Gender District 3-1 Final (%) State Final Sample (%) <37 weeks (n=13) 9.3 11.4 Male (n=78) 55.7 50.3 37+ weeks (n=127) Provider Type 90.7 88.6 Female (n=62) 44.3 49.7 Number of Providers Public Sector Only (n= N/A) - 2.0 1 (n= N/A) - 51.2 Private Sector Only (n= N/A) - 66.7 2 (n= N/A) - 17.2 Both (n= N/A) Payment at Birth, - 6.6 3+ (n= N/A) Maternal Age - 7.0 Government Assist (n=65) Private Insurance (n=49) 46.4 50.4 <25 years (n=38) 35.0 27.5 25-34 years (n=76) 38 41.3 54.3 47.1 Other (n=8) 5.7 5.0 35+ years (n=26) 18.6 11.6 Self Pay (n=4) 2.9 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xii Table 3-2-D: Sample Population Demographics, District 3-2, 2012 District State Final 3-2 Final % Sample % District 3-2 Final Sample n=194 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=53) 27.3 40.9 White, Hispanic (n=2) 1.0 4.3 Black (n=94) 48.5 37.0 Unspecified, Hispanic (n=31) 16.0 8.9 Asian (n=6) 3.1 2.2 Multiracial (n=4) Maternal Education, 2.1 1.6 Some College+ (n=93) 47.9 41.6 HS Diploma/GED (n=46) 23.7 30.1 9th-11th grade (n=32) 16.5 17.7 <9th grade (n=11) 5.7 6.2 WIC Notable Demographic Findings: The proportion of children w%ithofmFiontahlers %cloafssInifitiieadl as black was greater for tShaemDpliestrict saSmamppllee than for the overall state sample (48.5% vs. 37.0%) (Table 3-2-D). The proportion of children with mothers classified as white, non -Hispanic was smaller for the District sample than for the overall state sample (27.3% vs. 40.9%) For the District 3-2 sample, a slightly smaller proportion of children were enrolled in WIC than the total state sample (38.7% vs. 45.1%). A larger proportion of children in the District 3-2 sample had mothers with some college education than the state sample (47.9% vs. 41.6%). The District sample also had a larger proportion of children whose birth costs were covered by private insurance (38.7% vs. 27.5%) and a smaller proportion covered using government assistance (40.7% vs. 50.4%). Non-WIC (n=119) WIC (n=75) Metro Residence 61.3 54.9 Other demographic measures for this District 38.7 45.1 were similar to findings for the state sample as a whole. Metro (n=194) 100.0 76.1 Non-metro (n=0) Maternal Marital Status 0 23.8 Married (n=93) 47.9 49.0 Unmarried (n=101) Repeat Birth 52.1 50.8 First Child (n=95) Repeat Birth (n=99) Gestational Age 49.0 42.6 51.0 57.3 Child's Gender District 3-2 Final (%) State Final Sample (%) <37 weeks (n=17) 8.8 11.4 Male (n=90) 46.4 50.3 37+ weeks (n=177) Provider Type 91.2 88.6 Female (n=104) 53.6 49.7 Number of Providers Public Sector Only (n=3) 1.6 2.0 1 (n=103) 53.1 51.2 Private Sector Only (n=128) 66.0 66.7 2 (n=24) 12.4 17.2 Both (n=4) Payment at Birth, 2.1 6.6 3+ (n=8) Maternal Age 4.13 7.0 Government Assist (n=79) Private Insurance (n=75) 40.7 50.4 <25 years (n=66) 38.7 27.5 25-34 years (n=97) 34.0 41.3 50.0 47.1 Other (n=12) 6.2 5.0 35+ years (n=31) 16.0 11.6 Self Pay (n=9) 4.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xiii Table 3-3-D: Sample Population Demographics, District 3-3, 2012 District State Final 3-3 Final % Sample % District 3-3 Final Sample n=124 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=4) 3.2 40.9 White, Hispanic (n=2) 1.6 4.3 Black (n=75) 60.5 37.0 Unspecified, Hispanic (n=31) 25.0 8.9 Notable Demographic Findings: The pasrobploarctkiownaosfgcrheialtderrenfowr i%tthShoaefmmDFpoiilnstetahrleicrst cs%alaSmoasfsmpIinlpfeiilteeiadl than for the overall state sample (60.5% vs. 37.0%), as was the proportion of children with mothers classified as Hispanic (26.6% vs. 13.2%) (Table 3-3-D). The proportion of children with mothers classified as white, nonHispanic was much smaller for the District sample than for the overall state sample (3.2% vs. 40.9%) Asian (n=4) Multiracial (n=2) Maternal Education, Some College+ (n=40) HS Diploma/GED (n=39) 9th-11th grade (n=23) <9th grade (n=14) WIC Non-WIC (n=63) WIC (n=61) Metro Residence, Metro (n=123) 3.2 2.2 The proportion of children that were enrolled 1.6 1.6 in WIC in the District sample was slightly larger than the proportion in the total state sample (49.2% vs. 45.1%). 32.3 41.6 31.5 30.1 A smaller proportion of children in the District 18.6 17.7 3-3 sample had mothers with some college education than the state sample (32.3% vs. 11.3 6.2 41.6%). In addition, the District sample had a larger proportion of children whose birth costs were covered by self-pay (15.3% vs. 5.4%). 50.8 54.9 49.2 45.1 Other demographic measures for this District were similar to findings for the state sample as a whole. 99.2 76.1 Non-metro (n=0) Maternal Marital Status, 0 23.8 Married (n=48) 38.7 49.0 Unmarried (n=75) 60.5 50.8 Repeat Birth, First Child (n=48) Repeat Birth (n=75) Gestational Age 38.7 42.6 60.5 57.3 Child's Gender District State Final 3-3 Final % Sample % <37 weeks (n=10) 8.1 11.4 Male (n=62) 50.0 50.3 37+ weeks (n=114) Provider Type 91.9 88.6 Female (n=62) 50.0 49.7 Number of Providers Public Sector Only (n=1) 0.8 2.0 1 (n=65) 52.4 51.2 Private Sector Only (n=94) 75.8 66.7 2 (n=24) 19.4 17.2 Both (n=6) Payment at Birth, 4.9 6.6 3+ (n=11) Maternal Age 9.7 7.0 Government Assist (n=53) 42.7 50.4 <25 years (n=38) 30.7 41.3 Private Insurance (n=24) 19.4 27.5 25-34 years (n=67) 54.0 47.1 Other (n=10) 8.1 5.0 35+ years (n=19) 15.3 11.6 Self Pay (n=19) 15.3 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xiv Table 3-4-D: Sample Population Demographics, District 3-4, 2012 District State Final 3-4 Final % Sample % District 3-4 Final Sample n=195 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=46) 23.6 40.9 White, Hispanic (n=21) 10.8 4.3 Black (n=58) 29.7 37.0 Unspecified, Hispanic (n=38) 19.5 8.9 Asian (n=12) 6.2 2.2 Multiracial (n=4) Maternal Education, 2.1 1.6 Some College+ (n=84) 43.1 41.6 HS Diploma/GED (n=55) 28.2 30.1 9th-11th grade (n=19) 9.7 17.7 <9th grade (n=25) 12.8 6.2 WIC Non-WIC (n=111) 56.9 54.9 WIC (n=84) 43.1 45.1 Metro Residence Notable Demographic Findings: The proportion of children w%hoosfeFimnaolther%s wofeInreitial classified as Hispanic wasSgarmepalteer for tShaemple District sample than for the overall state sample (30.3% vs. 13.2%). The proportion of children whose mothers were classified as white, non-Hispanic was smaller for the District sample than for the state sample (23.6% vs. 40.9%) (Table 3-4-D). The proportion of children that were enrolled in WIC in the District sample was similar to the proportion enrolled in WIC in the total state sample (43.1% vs. 45.1%). The District sample had a larger proportion of children whose mothers were married than the state sample (61.0% vs. 49.0%). Similarly, the District sample had a larger proportion of those with providers in the Private Sector (73.3% vs. 66.7%). A much lower proportion of children were covered by government assistance at the time of birth than the state sample (30.3% vs. 50.4%). Metro (n=195) Non-metro (n=0) Maternal Marital Status 100.0 0 76.1 Other demographic measures for this District 23.8 were similar to findings for the state sample as a whole. Married (n=119) 61.0 49.0 Unmarried (n=76) Repeat Birth 39.0 50.8 First Child (n=78) Repeat Birth (n=117) Gestational Age 40.0 42.6 60.0 57.3 Child's Gender District State Final 3-4 Final % Sample % <37 weeks (n=20) 10.3 11.4 Male (n=99) 50.8 50.3 37+ weeks (n=175) Provider Type 89.7 88.6 Female (n=96) 49.2 49.7 Number of Providers Public Sector Only (n=5) 2.6 2.0 1 (n=97) 49.7 51.2 Private Sector Only (n=143) 73.3 66.7 2 (n=39) 20.0 17.2 Both (n=6) Payment at Birth, 3.1 6.6 3+ (n=18) Maternal Age 9.2 7.0 Government Assist (n=59) Private Insurance (n=61) 30.3 50.4 <25 years (n=66) 31.3 27.5 25-34 years (n=96) 33.9 41.3 49.2 47.1 Other (n=8) 4.1 5.0 35+ years (n=33) 16.9 11.6 Self Pay (n=11) 5.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xv Table 3-5-D: Sample Population Demographics, District 3-5, 2012 District State Final 3-5 Final % Sample % District 3-5 Final Sample n=150 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=34) 22.7 40.9 White, Hispanic (n=4) 2.7 4.3 Black (n=69) 46.0 37.0 Unspecified, Hispanic (n=19) 12.7 8.9 Asian (n=8) 5.3 2.2 Multiracial (n=2) 1.3 1.6 Notable Demographic Findings: The proportion of children wh%oosef Fminoatlhers%woef rIneitial classified as white, non-HiSsapmapnliec was smSaamlpleler for the District sample than for the overall state sample (22.7% vs. 40.9%). The proportion of children whose mothers were classified as black was greater for the District sample than for the state sample (46.0% vs. 37.0%) (Table 3 -5-D). The proportion of children that were enrolled in WIC in the District sample was similar to the proportion enrolled in WIC in the total state sample (43.4% vs. 45.1%). Maternal Education, Some College+ (n=67) HS Diploma/GED (n=41) 9th-11th grade (n=12) <9th grade (n=14) WIC Non-WIC (n=85) WIC (n=65) The District sample had a larger proportion of 44.7 41.6 children whose birth costs were covered by 27.3 30.1 private insurance (36.7% vs. 27.5%) vs. 8.0 17.7 government assistance (40.0% vs. 50.4%). In addition, the District sample had a smaller 9.3 6.2 proportion of first-born children compared to the state sample (37.3% vs. 42.6%) and a 56.7 54.9 smaller proportion of mothers age less than 25 years (28.0% vs. 41.3%). 43.3 45.1 Metro Residence Metro (n=150) Non-metro (n=0) Other demographic measures for this District were similar to findings for the state sample as 100 76.1 a whole. 0 23.8 Maternal Marital Status Married (n=72) 48.0 49.0 Unmarried (n=78) Repeat Birth 52.0 50.8 First Child (n=56) Repeat Birth (n=94) Gestational Age 37.3 42.6 62.7 57.3 Child's Gender District State Final 3-5 Final % Sample % <37 weeks (n=18) 12.0 11.4 Male (n=73) 48.7 50.3 37+ weeks (n=132) Provider Type 88.0 88.6 Female (n=77) 51.3 49.7 Number of Providers Public Sector Only (n=0) 0 2.0 1 (n=75) 50.0 51.2 Private Sector Only (n=99) 66.0 66.7 2 (n=21) 14.0 17.2 Both (n=6) Payment at Birth 4.0 6.6 3+ (n=9) Maternal Age 6.0 7.0 Government Assist (n=60) Private Insurance (n=55) 40.0 50.4 <25 years (n=42) 36.7 27.5 25-34 years (n=85) 28.0 41.3 56.7 47.1 Other (n=8) 5.3 5.0 35+ years (n=23) 15.3 11.6 Self Pay (n=16) 10.7 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xvi Table 4-0-D: Sample Population Demographics, District 4-0, 2012 District State Final 4-0 Final % Sample % District 4-0 Final Sample Maternal Race/Ethnicity, n=151 n=2,589 White, NonHispanic (n=79) 52.3 40.9 White, Hispanic (n=2) 1.3 4.3 Black (n=50 33.1 37.0 Unspecified, Hispanic (n=9) 6.0 8.9 Asian (n=4) 2.7 2.2 Multiracial (n=3) Maternal Education, 2.0 1.6 Some College+ (n=75) 49.7 41.6 HS Diploma/GED (n=28) 18.5 30.1 9th-11th grade (n=32) 21.2 17.7 <9th grade (n=3) 2.0 6.2 WIC Non-WIC (n=94) 62.3 54.9 WIC (n=57) Metro Residence 37.7 45.1 Metro (n=129) 85.4 76.1 Non-metro (n=22) Maternal Marital Status 14.6 23.8 Notable Demographic Findings: The proportion of children wh%oosfeFminoatl her%s owfeInrietial classified as white, non-HSisapmapnliec was gSraemaptlee r for the District sample than for the overall state sample (52.3% vs. 40.9%) (Table 4-0-D). The proportion of children that were enrolled in WIC in the District sample was slightly less than the proportion enrolled in WIC in the total state sample (37.7% vs. 45.1%). The District sample had a higher proportion of children whose mothers had some college education than the state sample (49.7% vs. 41.6%). In addition, the District sample had a greater proportion of children whose birth costs were covered by private insurance (39.7% vs. 27.5%) and a smaller proportion of children whose births were covered by government assistance (39.1% vs. 50.4%) than the state sample. The District also had a larger proportion of children whose provider was in the private sector (72.9% vs. 66.7%). Other demographic measures for this District were similar to findings for the state sample as a whole. Married (n=85) 56.3 49.0 Unmarried (n=66) Repeat Birth 43.7 50.8 First Child (n=68) Repeat Birth (n=83) Gestational Age 45.0 42.6 55.0 57.3 Child's Gender District State Final 4-0 Final % Sample % <37 weeks (n=13) 8.6 11.4 Male (n=84) 55.6 50.3 37+ weeks (n=138) Provider Type 91.4 88.6 Female (n=67) 44.4 49.7 Number of Providers Public Sector Only (n=5) 3.3 2.0 1 (n=77) 51.0 51.2 Private Sector Only (n=110) 72.9 66.7 2 (n=34) 22.5 17.2 Both (n=14) Payment at Birth 9.3 6.6 3+ (n=18) Maternal Age 12.0 7.0 Government Assist (n=59) 39.1 50.4 <25 years (n=62) 41.1 41.3 Private Insurance (n=60) 39.7 27.5 25-34 years (n=69) 45.7 47.1 Other (n=10) 6.6 5.0 35+ years (n=20) 13.3 11.6 Self Pay (n=3) 12.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xvii Table 5-1-D: Sample Population Demographics, District 5-1, 2012 District State Final 5-1 Final % Sample % District 5-1 Final Sample n=77 n=2,589 Maternal Race/Ethnicity, Notable Demographic Findings: The pclraospsoifriteidonasofwchhitiled,rennonw-Hhois%speoamnioctwhea%rsSsoagfwmrIenepialrteiteaelr for the District sample than for the overall state sample (49.4% vs. 40.9%). (Table 5-1D). White, NonHispanic (n=38) White, Hispanic (n=3) Black (n=31) Unspecified, Hispanic (n=2) Asian (n=1) 49.4 40.9 The proportion of children that were 3.9 4.3 enrolled in WIC in the District sample was 40.3 37.0 slightly larger when compared to the 2.6 8.9 proportion in the total state sample (49.4% vs. 45.1%). 1.3 2.2 Multiracial (n=0) Maternal Education, Some College+ (n=24) HS Diploma/GED (n=23) 9th-11th grade (n=15) <9th grade (n=3) WIC Non-WIC (n=39) WIC (n=38) Metro Residence Metro (n=0) Non-metro (n=77) Maternal Marital Status Married (n=42) Unmarried (n=34) Repeat Birth 0 1.6 The District sample had a smaller proportion of children whose mothers had some college education than the overall state sample 31.2 41.6 (31.2% vs. 41.6%). In addition, the District 29.9 30.1 sample had a larger proportion of children 19.5 17.7 whose birth costs were covered by government assistance (66.2% vs. 50.4%). 3.9 6.2 The District sample had a larger proportion 50.6 54.9 of children whose provider types were found in both sectors (private & public) than the 49.4 45.1 overall state sample (14.3% vs. 6.6%). Similarly, there was a higher proportion of 0 76.1 mothers for whom this child was not their first (67.5% vs. 57.3%). 100.0 23.8 Other demographic measures for this District were similar to findings for the state sample 54.6 49.0 as a whole. 44.2 50.8 First Child (n=25) Repeat Birth (n=52) Gestational Age 32.5 42.6 67.5 57.3 Child's Gender District State Final 5-1 Final % Sample % <37 weeks (n=3) 37+ weeks (n=74) 3.9 11.4 Male (n=40) 96.1 88.6 Female (n=37) 52.0 50.3 48.1 49.7 Provider Type Number of Providers Public Sector Only (n=4) 5.2 2.0 1 (n=49) 63.6 51.2 Private Sector Only (n=54) 70.1 66.7 2 (n=17) 22.1 17.2 Both (n=11) Payment at Birth 14.3 6.6 3+ (n=3) Maternal Age 3.9 7.0 Government Assist (n=51) 66.2 50.4 <25 years (n=28) 36.4 41.3 Private Insurance (n=15) 19.5 27.5 25-34 years (n=40) 52.0 47.1 Other (n=3) 3.9 5.0 35+ years (n=9) 11.7 11.6 Self Pay (n=1) 1.3 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xviii Table 5-2-D: Sample Population Demographics, District 5-2, 2012 District State Final 5-2 Final % Sample % District 5-2 Final Sample n=158 n=2,589 Maternal Race/Ethnicity, Notable Demographic Findings: The proportion of children w%hoosfeFimnaolthe%rsowf Ienriteial classified as white, non-HSiasmpapnleic or blSaacmkplwe as greater for the District sample than for the overall state sample (48.1% vs. 40.9%) and (45.6% vs. 37.0%), respectively (Table 5-2-D). White, NonHispanic (n=76) White, Hispanic (n=5) Black (n=72) Unspecified, Hispanic (n=2) 48.1 40.9 The proportion of children that were 3.2 4.3 enrolled in WIC in the District sample was 45.6 37.0 similar when compared to the proportion in 1.3 8.9 the total state sample (46.2% vs. 45.1%). Asian (n=1) Multiracial (n=1) Maternal Education, Some College+ (n=72) HS Diploma/GED (n=52) 9th-11th grade (n=23) 0.6 2.2 A larger proportion of children in the District 0.6 1.6 sample were covered through government assistance at birth than for the state sample as a whole (63.9% vs. 50.4%). Similarly, the 45.6 41.6 proportion of children having only one 32.9 30.1 provider was larger in the District (62.7% vs. 14.6 17.7 51.2%) than in the state sample. <9th grade (n=6) WIC Non-WIC (n=85) WIC (n=73) Metro Residence Metro (n=116) Non-metro (n=42) Maternal Marital Status 3.8 6.2 In District 5-2, a smaller proportion of children whose mothers were married 53.8 54.9 compared to that of the state sample (40.5% vs. 49.0%). 46.2 45.1 Other demographic measures for this District 73.4 76.1 were similar to findings for the state sample as a whole. 26.6 23.8 Married (n=64) 40.5 49.0 Unmarried (n=94) 59.5 50.8 Repeat Birth First Child (n=63) Repeat Birth (n=95) Gestational Age 39.9 42.6 60.1 57.3 Child's Gender District State Final 5-2 Final % Sample % <37 weeks (n=26) 16.5 11.4 Male (n=78) 49.4 50.3 37+ weeks (n=132) Provider Type 83.5 88.6 Female (n=80) 50.6 49.7 Number of Providers Public Sector Only (n=2) 1.3 2.0 1 (n=99) 62.7 51.2 Private Sector Only (n=115) 72.8 66.7 2 (n=21) 13.3 17.2 Both (n=10) 6.3 6.6 3+ (n=7) 4.4 7.0 Payment at Birth Maternal Age Government Assist (n=101) 63.9 50.4 <25 years (n=69) 43.7 41.3 Private Insurance (n=46) 29.1 27.5 25-34 years (n=78) 49.4 47.1 Other (n=3) 1.9 5.0 35+ years (n=11) 7.0 11.6 Self Pay (n=6) 3.8 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xix Table 6-0-D: Sample Population Demographics, District 6-0, 2012 Notable Demographic Findings: The District 6-0 Final % State Final Sample % pcDlriasotsprsoiicfritteitdohnaasonfbfcolahrcitlkdhwreeaonsvwemr%huaSocloaslhfmesFtphmialniegtaoehltehsrearmSf%soinpoarwfDlmteeiIhpsnrtlieeetriiactl District 6-0 Final Sample Maternal Race/Ethnicity, n=159 n=2,589 (58.5% vs. 37.0%) (Table 6-0-D) and lower for white non-Hispanic and white Hispanic mothers (31.5% vs. 40.9%) and (1.9% vs. White, NonHispanic (n=50) 31.5 40.9 4.3%) respectively. White, Hispanic (n=3) Black (n=93) Unspecified, Hispanic (n=5) Asian (n=1) 1.9 4.3 The proportion of children that were enrolled 58.5 37.0 in WIC in the District sample was higher when 3.1 8.9 compared to the proportion in the total state 0.6 2.2 sample (52.2% vs. 45.1%). Multiracial (n=4) Maternal Education, Some College+ (n=58) HS Diploma/GED (n=63) 9th-11th grade (n=34) <9th grade (n=4) WIC Non-WIC (n=76) WIC (n=83) 2.5 1.6 In addition, the District sample had a smaller proportion of children whose mothers were 36.5 41.6 married than the state sample (32.7% vs. 39.6 30.1 49.0%). Similarly, there was a smaller proportion of mothers with some college+ 21.4 17.7 education (36.5% vs. 41.6%). 2.5 6.2 The District sample had a much higher number of children whose birth costs were 47.8 54.9 covered through government assistance 52.2 45.1 (73.0% vs. 50.4%) than the state sample. Metro Residence Metro (n=120) Non-metro (n=39) Maternal Marital Status Other demographic measures for this District 75.5 76.1 were similar to findings for the state sample 24.5 23.8 as a whole. Married (n=52) 32.7 49.0 Unmarried (n=107) Repeat Birth 67.3 50.8 First Child (n=60) Repeat Birth (n=99) Gestational Age 37.7 42.6 62.3 57.3 Child's Gender District State Final 6-0 Final % Sample % <37 weeks (n=23) 14.5 11.4 Male (n=68) 42.8 50.3 37+ weeks (n=136) Provider Type 85.5 88.6 Female (n=91) 57.2 49.7 Number of Providers Public Sector Only (n=4) 2.5 2.0 1 (n=98) 61.6 51.2 Private Sector Only (n=104) 65.4 66.7 2 (n=18) 11.3 17.2 Both (n=18) Payment at Birth 11.3 6.6 3+ (n=10) Maternal Age 6.3 7.0 Government Assist (n=116) 73.0 50.4 <25 years (n=71) 44.7 41.3 Private Insurance (n=36) 22.6 27.5 25-34 years (n=74) 46.5 47.1 Other (n=1) 0.6 5.0 35+ years (n=14) 8.8 11.6 Self Pay (n=3) 1.9 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xx Table 7-0-D: Sample Population Demographics, District 7-0, 2012 District State Final 7-0 Final % Sample % District 7-0 Final Sample n=156 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=49) 31.4 40.9 Notable Demographic Findings: The proportion of children w%hoosfeFimnaolthe%rsofwIenirteial classified as black was greSaamteprlefor theSample District sample than for the overall state sample (55.1% vs. 37.0%) and the proportion of mothers classified as white, non-Hispanic mothers was lower (31.4% vs. 40.9%). White, Hispanic (n=0) Black (n=86) Unspecified, Hispanic (n=7) Asian (n=3) 0 4.3 The proportion of children that were 55.1 37.0 enrolled in WIC in the District sample were 4.5 8.9 higher than the proportion in the total state sample (57.1% vs. 45.1%). 1.9 2.2 Multiracial (n=2) Maternal Education, Some College+ (n=64) HS Diploma/GED (n=50) 9th-11th grade (n=34) 1.3 1.6 The District sample also had a larger proportion of children with unmarried mothers than the overall state sample 41.0 41.6 (64.4% vs. 50.8%), as well as a larger 32.1 30.1 proportion of children with mothers less 21.8 17.7 than 25 years of age (50.6% vs. 41.3%). <9th grade (n=7) WIC Non-WIC (n=67) WIC (n=89) Metro Residence Metro (n=102) Non-metro (n=54) Maternal Marital Status 4.5 6.2 The District 7-0 sample had a smaller proportion of children whose births were 42.9 54.9 covered by private insurance compared to the state sample (19.2% vs. 27.5%). 57.1 45.1 Other demographic measures for this 65.4 76.1 District were similar to findings for the state sample as a whole. 34.6 23.8 Married (n=54) 34.6 49.0 Unmarried (n=102) 64.4 50.8 Repeat Birth First Child (n=61) Repeat Birth (n=95) Gestational Age 39.1 42.6 60.9 57.3 Child's Gender District State Final 7-0 Final % Sample % <37 weeks (n=25) 37+ weeks (n=131) Provider Type 16.0 11.4 Male (n=77) 49.4 50.3 84.0 88.6 Female (n=79) 50.6 49.7 Number of Providers Public Sector Only (n=1) 0.6 2.0 1 (n=66) 42.3 51.2 Private Sector Only (n=101) 64.7 66.7 2 (n=31) 19.9 17.2 Both (n=10) 6.4 6.6 3+ (n=15) 9.6 7.0 Payment at Birth Maternal Age Government Assist (n=85) 54.5 50.4 <25 years (n=79) 50.6 41.3 Private Insurance (n=30) 19.2 27.5 25-34 years (n=69) 44.2 47.1 Other (n=22) 14.1 5.0 35+ years (n=8) 5.1 11.6 Self Pay (n=9) 5.8 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxi Table 8-1-D: Sample Population Demographics, District 8-1, 2012 Notable Demographic Findings: The District 8-1 Final Sample District 8-1 Final % n=81 State Final Sample % n=2,589 proportion of children w%hoosfeFminaolthe%rsowf Ienriteial classified as black was greSaamteprlefor theSaDmisptlerict sample than for the overall state sample (43.2% vs. 37.0%) (Table 8-1-D). Maternal Race/Ethnicity, White, NonHispanic (n=28) White, Hispanic (n=3) 34.6 40.9 The proportion of children that were enrolled in WIC in the District sample was somewhat 3.7 4.3 higher than the proportion in the total state Black (n=35) 43.2 37.0 sample (53.1% vs. 45.1%). Unspecified, Hispanic (n=5) Asian (n=0) Multiracial (n=0) Maternal Education, Some College+ (n=34) HS Diploma/GED (n=30) 9th-11th grade (n=13) <9th grade (n=2) WIC Non-WIC (n=38) WIC (n=43) Metro Residence Metro (n=48) Non-metro (n=33) Maternal Marital Status 6.2 8.9 A larger proportion of children in the District 0 2.2 sample had unmarried mothers than the state 0 1.6 sample (60.5% vs. 50.8%) as well as a larger proportion of children who were firstborn than for the state sample as a whole (54.3% 42.0 41.6 vs. 42.6%). 37.0 30.1 16.1 17.7 The District sample had a higher number of children who were covered through 2.5 6.2 government assistance at the time of birth (75.3% vs. 50.4%). In addition, the District 46.9 54.9 sample had a higher number of children with mothers less than 25 years of age (59.3% vs. 53.1 45.1 41.3%) than the state sample. 59.3 76.1 Other demographic measures for this District were similar to findings for the state sample 40.7 23.8 as a whole. Married (n=32) 39.5 49.0 Unmarried (n=49) Repeat Birth 60.5 50.8 First Child (n=44) Repeat Birth (n=37) Gestational Age 54.3 42.6 45.7 57.3 Child's Gender District State Final 8-1 Final % Sample % <37 weeks (n=8) 9.9 11.4 Male (n=39) 48.2 50.3 37+ weeks (n=73) Provider Type 90.1 88.6 Female (n=42) 51.9 49.7 Number of Providers Public Sector Only (n=0) 0 2.0 1 (n=38) 47.0 51.2 Private Sector Only (n=69) 85.2 66.7 2 (n=23) 28.4 17.2 Both (n=7) Payment at Birth 8.6 6.6 3+ (n=15) Maternal Age 18.5 7.0 Government Assist (n=61) Private Insurance (n=11) 75.3 50.4 <25 years (n=48) 13.6 27.5 25-34 years (n=28) 59.3 41.3 34.6 47.1 Other (n=1) 1.2 5.0 35+ years (n=5) 6.2 11.6 Self Pay (n=1) 1.2 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxii Table 8-2-D: Sample Population Demographics, District 8-2, 2012 District State Final 8-2 Final % Sample % District 8-2 Final Sample n=132 n=2,589 Maternal Race/Ethnicity, White, NonHispanic (n=55) 41.7 40.9 White, Hispanic (n=0) 0 4.3 Black (n=64) 48.5 37.0 Notable Demographic Findings: The proportion of children w%hoosfeFimnaolthe%rsowf Ienriteial classified as black was greSaamteprlefor theSample District sample than for the overall state sample (48.5% vs. 37.0%) (Table 8-2-D). The proportion of children that were enrolled in WIC in the District sample was slightly higher than the total state sample (50.8% vs. 45.1%). Unspecified, Hispanic (n=11) Asian (n=0) Multiracial (n=1) Maternal Education, Some College+ (n=47) HS Diploma/GED (n=50) 8.3 8.9 The District sample had a larger proportion 0 2.2 of mothers who were unmarried (65.2% vs. 0.8 1.6 50.8%) along with a larger proportion of children whose mothers were in the <25 years age group (55.3 vs. 41.3%) than the 35.6 41.6 state sample. 37.9 30.1 9th-11th grade (n=26) <9th grade (n=7) WIC Non-WIC (n=65) WIC (n=67) Metro Residence 19.7 17.7 The District also had a large proportion of children who had payment at birth 5.3 6.2 information missing (43.9%) for reasons that are unknown, which could account for the 49.2 54.9 major difference in the proportion of children whose birth was covered by private 50.8 45.1 insurance between the District and State samples (5.3% vs. 27.5%). Metro (n=51) Non-metro (n=81) Maternal Marital Status 38.6 76.1 Other demographic measures for this District 61.4 23.8 were similar to findings for the state sample as a whole. Married (n=46) 34.9 49.0 Unmarried (n=86) Repeat Birth 65.2 50.8 First Child (n=59) Repeat Birth (n=73) Gestational Age 44.7 42.6 55.3 57.3 Child's Gender District State Final 8-2 Final % Sample % <37 weeks (n=14) 10.6 11.4 Male (n=67) 50.8 50.3 37+ weeks (n=118) Provider Type 89.4 88.6 Female (n=65) 49.2 49.7 Number of Providers Public Sector Only (n=8) 6.1 2.0 1 (n=82) 62.1 51.2 Private Sector Only (n=86) 65.2 66.7 2 (n=24) 18.2 17.2 Both (n=15) Payment at Birth 11.4 6.6 3+ (n=3) Maternal Age 2.3 7.0 Government Assist (n=49) Private Insurance (n=7) 37.1 50.4 <25 years (n=73) 5.3 27.5 25-34 years (n=49) 55.3 41.3 37.1 47.1 Other (n=8) 6.1 5.0 35+ years (n=10) 7.6 11.6 Self Pay (n=10) 7.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxiii Table 9-1-D: Sample Population Demographics, District 9-1--2012 Notable Demographic Findings: The District State Final proportion of children w%hoosfeFminoalthe%rsowf Ienriteial 9-1 Final % Sample % classified as Hispanic was hleigshsefror theSDamisptrleict District 9-1 Final Sample Maternal Race/Ethnicity, n=181 n=2,589 sample than for the overall state sample (7.2% vs. 13.2%) (Table 9-1-D). White, NonHispanic (n=73) White, Hispanic (n=7) Black (n=80) 40.3 40.9 The proportion of children that were enrolled in WIC in the District sample was similar than 3.9 4.3 the proportion in the total state sample 44.2 37.0 (45.9% vs. 45.1%). Unspecified, Hispanic (n=6) Asian (n=2) Multiracial (n=7) Maternal Education, Some College+ (n=80) HS Diploma/GED (n=52) 3.3 8.9 1.1 2.2 A larger proportion of children in the District 9-1 sample had mothers who were unmarried 3.9 1.6 than the state as a whole (60.2% vs. 50.8%). The District sample also had a higher number of infants whose births were covered by 44.2 41.6 government assistance (68.5% vs. 50.4%)than 28.7 30.1 the state sample. 9th-11th grade (n=34) <9th grade (n=12) WIC 18.8 17.7 6.6 6.2 Other demographic measures for this District were similar to findings for the state sample as a whole. Non-WIC (n=98) 54.1 54.9 WIC (n=83) Metro Residence 45.9 45.1 Metro (n=171) 94.5 76.1 Non-metro (n=10) Maternal Marital Status 5.5 23.8 Married (n=72) 39.8 49.0 Unmarried (n=109) Repeat Birth 60.2 50.8 First Child (n=77) Repeat Birth (n=104) Gestational Age 42.5 42.6 57.5 57.3 Child's Gender District State Final 9-1 Final % Sample % <37 weeks (n=20) 11.1 11.4 Male (n=90) 49.7 50.3 37+ weeks (n=161) Provider Type 89.0 88.6 Female (n=91) 50.3 49.7 Number of Providers Public Sector Only (n=3) 1.7 2.0 1 (n=108) 59.7 51.2 Private Sector Only (n=144) 79.6 66.7 2 (n=38) 21.0 17.2 Both (n=8) Payment at Birth 4.4 6.6 3+ (n=9) Maternal Age 5.0 7.0 Government Assist (n=124) 68.5 50.4 <25 years (n=79) 43.7 41.3 Private Insurance (n=45) 24.9 27.5 25-34 years (n=85) 47.0 47.1 Other (n=3) 1.7 5.0 35+ years (n=17) 9.4 11.6 Self Pay (n=4) 2.2 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxiv Table 9-2-D: Sample Population Demographics, District 9-2, 2012 District State Final 9-2 Final % Sample % District 9-2 Final Sample n=128 n=2,589 Maternal Race/Ethnicity, Notable Demographic Findings: The pclraospsoifriteidonasofwchhitiled,rennonw-%HhSooiasfsmpeFpaimlnneaiocl twhea%rssSogafwmrIenepialrteteiaelr for the District sample than for the overall state sample (51.6% vs. 40.9%) (Table 9-2D). White, NonHispanic (n=66) White, Hispanic (n=5) Black (n=43) Unspecified, Hispanic (n=9) 51.6 40.9 The proportion of children that were 3.9 4.3 enrolled in WIC in the District sample was 33.6 37.0 slightly higher than the proportion in the 7.0 8.9 total state sample (51.6% vs. 45.1%). Asian (n=0) Multiracial (n=3) Maternal Education, Some College+ (n=40) 0 2.2 The District 9-2 sample had a smaller 2.3 1.6 proportion of children whose mothers had some college education than the state sample (31.2% vs. 41.6%). 31.2 41.6 HS Diploma/GED (n=50) 9th-11th grade (n=30) <9th grade (n=6) WIC Non-WIC (n=62) WIC (n=66) Metro Residence Metro (n=1) Non-metro (n=127) Maternal Marital Status Married (n=59) Unmarried (n=69) Repeat Birth 39.1 30.1 A larger proportion of children received 23.4 17.7 immunizations from both public and private providers in the District 9-2 sample (20.3% 4.7 6.2 vs. 6.6%) than the state sample. 48.4 54.9 More children in the District sample received government assistance at the time of birth 51.6 45.1 (70.3% vs. 50.4%), and a larger proportion of children had mothers in the <25 years age 0.8 76.1 group (54.7% vs. 41.3%) than the state sample. 99.2 23.8 Other demographic measures for this District were similar to findings for the state sample 46.1 49.0 as a whole. 53.9 50.8 First Child (n=49) Repeat Birth (n=79) Gestational Age 38.3 42.6 61.7 57.3 Child's Gender District State Final 9-2 Final % Sample % <37 weeks (n=20) 15.6 11.4 Male (n=62) 48.4 50.3 37+ weeks (n=108) Provider Type 84.4 88.6 Female (n=66) 51.6 49.7 Number of Providers Public Sector Only (n=7) 5.5 2.0 1 (n=82) 64.1 51.2 Private Sector Only (n=91) 71.1 66.7 2 (n=35) 27.3 17.2 Both (n=26) Payment at Birth 20.3 6.6 3+ (n=7) Maternal Age 5.5 7.0 Government Assist (n=90) 70.3 50.4 <25 years (n=70) 54.7 41.3 Private Insurance (n=23) 18.0 27.5 25-34 years (n=49) 38.3 47.1 Other (n=0) 0 5.0 35+ years (n=9) 7.0 11.6 Self Pay (n=11) 8.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxv Table 10-0-D: Sample Population Demographics, District 10, 2012 Notable Demographic Findings: The District 10 Final Sample District 10 Final % n=167 State Final Sample % n=2,589 proportion of children w%hoosfeFimnaolthe%rsowf Ienirteial classified as white, non-HSiasmpapnleic wasSgarmepalteer for the District sample than for the overall state sample (54.5% vs. 40.9%) while the Maternal Race/Ethnicity, proportion of children whose mothers were White, NonHispanic (n=91) White, Hispanic (n=13) 54.5 40.9 classified as black was less (25.2% vs. 37.0%) (Table 10-0-D). 7.8 4.3 Black (n=42) Unspecified, Hispanic (n=11) Asian (n=3) Multiracial (n=2) Maternal Education, Some College+ (n=72) HS Diploma/GED (n=44) 9th-11th grade (n=40) <9th grade (n=4) WIC 25.2 37.0 The proportion of children that were 6.6 8.9 enrolled in WIC in the District sample was slightly lower than the proportion in the 1.8 2.2 total state sample (38.3% vs. 45.1%). 1.2 1.6 The District sample also had a lower proportion of children with unmarried 43.1 41.6 mothers than the state sample (46.1% vs. 26.4 30.1 50.8%). 24.0 17.7 Other demographic measures for this District 2.4 6.2 were similar to findings for the state sample as a whole. Non-WIC (n=103) 61.7 54.9 WIC (n=64) 38.3 45.1 Metro Residence Metro (n=125) 74.9 76.1 Non-metro (n=42) Maternal Marital Status 25.2 23.8 Married (n=89) 53.3 49.0 Unmarried (n=77) 46.1 50.8 Repeat Birth First Child (n=76) Repeat Birth (n=91) Gestational Age 45.5 42.6 54.5 57.3 Child's Gender District State Final 10 Final % Sample % <37 weeks (n=19) 37+ weeks (n=148) Provider Type 11.4 11.4 Male (n=85) 50.9 50.3 88.6 88.6 Female (n=82) 49.1 49.7 Number of Providers Public Sector Only (n=2) 1.2 2.0 1 (n=69) 41.3 51.2 Private Sector Only (n=97) 58.1 66.7 2 (n=27) 16.2 17.2 Both (n=7) Payment at Birth 4.2 6.6 3+ (n=10) Maternal Age 6.0 7.0 Government Assist (n=89) 53.3 50.4 <25 years (n=71) 42.5 41.3 Private Insurance (n=41) 24.6 27.5 25-34 years (n=79) 47.3 47.1 Other (n=0) 0 5.0 35+ years (n=17) 10.2 11.6 Self Pay (n=11) 6.6 5.4 Please see Appendix B for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. xxvi Appendix E: District immunization Measures, p1 Appendix Table E-1: District Immunization Coverage Rates, 2012 Highest Rate A. District Response Rate B. UTD by 24 months, 2012 C. UTD by end of data collection, 2012 D. Average Response Rate, 2005-2012* E. Average UTD by 24 months, 2005-2012* F. Percent change in UTD by 24 months, 2011 to 2012 G. Percent change in UTD by end of data collection, 2011 to 2012 H. Percent change in UTD from 24 months to end of data collection, 2012 *Immunization Rate not calculated for 2009 District A (%) 1-1 Northwest (Rome) 87.6 1-2 North Georgia (Dalton) 96.0 2-0 North (Gainesville) 100 3-1 Cobb-Douglas 89.8 3-2 Fulton 89.1 3-3 Clayton 91.9 3-4 Gwinnett, Newton, Rockdale 90.7 3-5 DeKalb 83.4 4-0 LaGrange 86.3 5-1 South Central (Dublin) 94.0 5-2 North Central (Macon) 97.5 6-0 East Central (Augusta) 99.4 7-0 West Central (Columbus) 92.5 8-1 South (Valdosta) 93.1 8-2 Southwest (Albany) 95.0 9-1 Coastal (Savannah) 89.7 9-2 Southeast (Waycross) 95.5 10-0 Northeast (Athens) Georgia 98.2 92.3 B (%) 92.9 87.4 84.1 82.9 77.3 83.9 81.5 87.3 88.1 77.9 85.4 82.4 91.0 88.9 83.3 80.7 84.4 85.0 84.5 C (%) 96.9 95.1 94.4 95.0 84.0 95.2 91.8 98.0 96.7 93.5 93.7 93.7 98.7 96.3 88.6 93.4 93.8 90.4 93.6 D (%) 89.8 98.3 97.3 90.9 84.2 87.0 93.0 83.6 92.2 97.0 93.5 99.4 92.1 93.2 95.6 88.3 96.4 93.0 91.0 E (%) 79.5 82.8 85.4 75.4 69.2 68.7 83.1 76.2 76.1 77.2 79.1 84.0 78.1 81.4 77.4 74.0 75.9 82.3 76.2 F (%) 5.2 11.6 -2.4 -3.2 -5.6 -0.8 1.9 2.9 8.4 -2.6 2.3 4.6 16.2 -2.2 -0.7 5.1 0.7 7.9 2.5 G (%) 1.3 4.2 -0.1 0.7 -11.0 0.0 -1.6 2.4 8.0 -0.5 -5.4 -5.2 10.2 0.2 -8.5 -0.3 1.1 -2.7 -0.4 H (%) 4.3 8.8 12.2 14.6 8.7 13.5 12.6 12.3 9.8 20.0 9.7 13.7 8.5 8.3 6.4 15.7 11.1 6.4 10.8 xxvii Appendix E: District immunization Measures, p2 Appendix Table E-2: District Vaccine Antigen-Specific Immunization Measures, 2012 Highest Rate District 4 3+ DTaP Polio (%) (%) 1-1 Northwest (Rome) 95.3 97.6 1-2 North Georgia (Dalton) 90.2 97.9 2-0 North (Gainesville) 86.5 96.8 3-1 Cobb-Douglas 85.7 94.3 3-2 Fulton 83.0 91.2 3-3 Clayton 84.7 95.2 3-4 Gwinnett, Newton, Rockdale 83.6 95.9 3-5 DeKalb 90.0 98.0 4-0 LaGrange 89.4 97.4 5-1 South Central (Dublin) 79.2 92.2 5-2 North Central (Macon) 86.1 95.6 6-0 East Central (Augusta) 84.3 95.6 7-0 West Central (Columbus) 93.6 98.7 8-1 South (Valdosta) 90.1 98.8 8-2 Southwest (Albany) 86.4 93.2 9-1 Coastal (Savannah) 85.1 98.3 9-2 Southeast (Waycross) 83.6 95.3 10-0 Northeast (Athens) Georgia 89.2 95.8 87.0 96.0 1 MMR (%) 96.9 95.8 96.0 90.7 87.1 94.4 91.8 96.0 96.7 85.7 93.0 89.9 96.8 95.1 91.7 91.7 94.5 94.6 93.2 UTD Hib (%) 98.4 97.9 96.8 93.6 93.8 93.6 96.9 97.3 98.7 90.9 95.6 93.7 98.7 95.1 95.5 96.7 96.1 98.2 96.1 HepB 3 1 UTD Birth HepB Varic. PCV (%) (%) (%) (%) 85.8 97.6 98.4 96.9 76.9 98.6 97.9 93.0 69.8 93.5 95.2 90.5 70.0 95.0 91.4 92.1 84.0 93.3 88.7 86.6 89.5 96.0 96.0 92.0 77.9 92.8 91.8 91.3 82.7 96.0 96.7 96.0 82.8 98.7 98.7 96.0 88.3 96.1 87.0 89.6 90.5 96.2 94.3 91.8 83.6 93.7 91.8 88.1 94.2 99.4 96.2 95.5 91.4 98.8 97.5 98.8 87.1 96.2 90.2 88.6 86.2 98.9 94.5 90.1 86.7 96.9 93.8 89.1 68.3 95.2 95.8 97.0 82.7 96.1 94.2 92.2 2+ Rota. (%) 78.7 69.9 89.7 75.7 73.2 62.9 81.0 75.3 66.2 45.5 52.5 62.9 65.4 84.0 78.8 61.9 64.1 79.0 70.6 1+ Flu (%) 64.6 71.3 69.1 60.0 57.2 41.9 59.0 64.0 51.7 46.8 50.6 52.2 59.0 58.0 56.8 59.7 50.8 50.3 57.1 xxviii Additional Resources For more information about the Georgia Department of Public Health Immunization Program, please visit the following website: http://dph.georgia.gov/immunization-section For past Georgia Immunization Study Final Reports, please visit the following website: http://dph.georgia.gov/immunization-publications For more information about the Georgia Department of Public Health Acute Disease Epidemiology Unit, please visit the following website: http://dph.georgia.gov/acute-disease-epidemiology For more information about the Centers for Disease Control and Prevention's (CDC) National Immunization Survey (NIS), please visit the following website: http://www.cdc.gov/nchs/nis.htm To access current vaccine schedules, vaccine information sheets and other immunization materials, please visit the Immunization Action Coalition website: http://www.immunize.org For questions relating specifically to this document, please email the author at mtrema@dhr.state.ga.us xxix