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Data extraction
Study; Country | SES Concept (Level of SES measure) | Description SES measure | Adjusted mediating factorsa | Data source; Data type (Year collected) | Results |
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Education (n = 6; 3 positive associations, 1 negative association, 2 no association) | |||||
Barbadoro 2013 [13]; Italy | Education (Individual) | Level of education level (low, medium, high, 3-yr university degree, more than 4 years university degree, post-graduate) | Sociodemographic and clinical variables | Health and Use of Health Care in Italy; National Survey (2004–05) | Positive association. Healthcare workers in Italy with low (0.57OR, 0.39–0.81CI), medium (0.51OR, 0.37–0.71CI), or high (0.54OR, 0.39–0.71CI) education levels were less likely to be vaccinated compared to those with a post-graduate degree. |
Cohen 2012 [14]; US | Education (Individual) | Low (less than HS, HS, or GED) or high (some college or college diploma) levels of education | Sociodemographic, health, clinical, and health belief variables | Participants of a RCT on flu transmission; Study in Washington Heights, New York (2006) | Positive association. Adults with higher levels of education were more likely to be vaccinated (1.20OR, 1,05–1,37CI) than those with lower levels. No significant relationship was found for children. |
Henninger 2015 [15]; US | Education (Individual) | Education level (HS or GED or less, some college, bachelor’s degree, master’s degree or higher) | Sociodemographic variables, obstetric characteristics, survey items, and vaccination status | Pregnancy and Influenza Project; Large cohort of pregnant women seeking care from Kaiser Pemanente Northwest and Northern California (2010–11) | No association. Education level was not significantly associated with vaccination during pregnancy after adjusting for race and provider recommendation. |
Jimenez-Trujillo 2015 [16]; Spain | Education (Individual) | Education level (primary, secondary, university) | Sociodemographic variables, health status and clinical variables | European Health Survey for Spain and Spanish National Health Survey; National Survey (2009; 2011) | No association. There was no significant association found between education level and influenza vaccine among persons aged 40–69 years with diabetes. |
Lorenz 2013 [17]; US | Education (Individual) | Education level (less than HS, HS, more than HS) | Not reported | Patient survey and electronic medical records; Statewide survey and electronic medical records (2010–12) | Negative association. Mentally ill patients in Alabama with more than a high school education were less likely (0.29OR, 0.09–0.96CI) to be vaccinated compared to those with less than a high school education. |
Simon 2016 [18]; US | Education (Individual) | Parents’ highest level of education (less than HS, HS graduate or GED, some college or associated degree, technical school degree, college degree or more) | Not reported | National Health Interview Survey; National survey (2005–13) | Positive association. Children with asthma whose parents had a college degree or higher (reference group) were more likely to receive influenza vaccination compared to those with parents who had some college, an associate’s degree, or some technical school (0.62 OR, 0.42–0.91 CI). |
Occupational class (n = 1; 1 positive association) | |||||
Cleary 2014 [19]; Ireland | Class (Individual) | Socioeconomic group (occupational class): home duties, professional / manager / employer / non-manual, manual, unemployed, non-classifiable | Sociodemographic and pregnancy-related clinical variables; no adjustment was done in calculation for vaccination by SES group | Antenatal booking interview hospital data; Medical and clinical admission records (2009–10) | Positive association. Pregnant women from the professional / manager / employer group were more likely to be vaccinated against H1N1 than women in all other SES groups: home duties (0.61OR, 0.52–0.70CI), non-manual (0.81OR, 0.72–9.92CI), manual (0.54OR, 0.42–0.69CI), unemployed (0.77OR, 0.64–0.93CI), or non-classifiable (0.69OR, 0.55–0.87CI). |
Income or poverty (n = 5; 5 positive associations) | |||||
Campitelli 2012 [20]; Canada | Income (Neighbourhood) | Linked postal code of residence to mean household income quintile in area (Q1 = lowest SES, Q5 = highest SES) | Sociodemographic and clinical variables | Hospital discharge, abstracts, physician claims, and other databases; Linked administrative data (2002–12) | Positive association. Infants from higher SES quintiles were more likely to be fully vaccinated against influenza during their first eligible winter, compared to children from lower SES areas (Q2 = 1.08OR, 1.04–1.11CI, Q3 = 1.12OR, 1.09–1.16CI, Q4 = 1.20OR, 1.23–1.32CI). The association remained significant for SES quintiles 3, 4, and 5 among low-birth weight infants. |
Fox 2014 [21]; US | Income (Individual) | Federal poverty level for 2012: income above 200% the poverty level, income equal to or less than 200% poverty level | None | National Health Interview Survey; National survey (2011–12) | Positive association. Adults with a family income above 200% the federal poverty level were significantly more likely to receive an influenza vaccination compared to those below it (1.3PR, 1.3–1.3CI) |
Lau 2013 [22]; US | Income (Household) | Household income percent of federal poverty level: 0–99%, 100–199%, 200–299, 300% or more | Sociodemographic variables, insurance status, and usual source of care | California Health Interview Survey; State survey (2005; 2007) | Positive association. After adjusting for gender, race/ethnicity, income, insurance status, and usual source of care, young adults aged 18 to 26 years with household incomes 200–299% above the federal poverty limit (1.57OR, 1.11–2.21CI) were more likely to be vaccinated compared to young adults of the same age with household incomes 0–99% FPL. |
Narciso 2012 [23]; US | Income (Neighbourhood) | Neighbourhood poverty level (high [> 30% residents living below poverty], medium [20–29.9% residents living below poverty], low [less than 20% living below poverty level]) | Not reported | Vaccination data from school-located vaccination campaign; New York City schools (2009–10) | Positive association. The authors report lower levels of vaccination in boroughs with higher levels of poverty and provide the following vaccination prevalence rates: Manhattan (27.5%), Bronx (18.4%), Brooklyn (19.4%), Staten Island (16.9%), Queens (24.2%). |
Villarroel 2016 [24]; US | Income (Household) | Income level (poor: below FPL, near-poor: 100% to less than 200% FPL, not poor: 200% or greater FPL) | Not reported | National Health Interview Survey; National survey (2015) | Positive association. Among adults diagnosed with diabetes, 50.9% who were poor had received an influenza vaccine, compared to those who were 57.8% near-poor and 65.9% not-poor. This linear trend was significant at p < 0.05. |
Study; Country | SES Concept (Level of SES measure) | Description SES measure | Adjusted mediating factorsa | Data source; Data type (Year collected) | Results |
---|---|---|---|---|---|
Education and social or occupational class (n = 2; 1 positive association, 1 no association) | |||||
LaVela 2012 [25]; US | Education and employment (Individual) | Education level: did not graduate HS, HS or more Employment status: currently employed for wages, or not | Sociodemographic characteristics, characteristics of multiple sclerosis, comorbidities | Behavioral Risk Factor Surveillance System and Multiple Sclerosis Health Care Questionnaire; National survey (2003) | No association. There was no significant association between influenza vaccination, being in paid employment, or having completed high school among men age 50 or older with multiple sclerosis. |
Lu 2015 [26]; US | Education and employment (Individual) | Employment status (employed, unemployed, not in work force) Education level (less than HS, HS, college or more) | Sociodemographic variables and health service variables | National Health Information Survey; National survey (2012) | Positive association. Adults aged 19–64 with college education or higher were more likely (1.18, 1.09–1.27CI) to receive a vaccination compared to persons with HS, as were persons aged 65 and older (1.11APR, 1.04–1.18CI). Unemployed adults were less likely to be vaccinated compared to employed adults (0.89APR, 0.80–1.00CI), but among the elderly, unemployed persons were more likely to be vaccinated (1.10APR, 1.03–1.17CI). |
Education and income or poverty (n = 15; 7 positive associations; 6 mixed findings; 2 no association) | |||||
Barbadoro 2016 [27]; Italy | Education and income (Individual) | Education level (low, medium-low, medium-high, high) Wealth (1 = low, 2, 3, 4 = high) | Sociodemographic and clinical variables | Health and Health Care use in Italy; National survey (2004–05; 2013) | Mixed findings. Obese persons with medium-high levels of education were less likely to be vaccinated compared to persons with low levels of education in two age groups: 18–64 years (0.77OR, 0.62–0.96CI) and 64 and older (0.79OR, 0.63–0.98CI). No association was found with income. |
Blackwell 2015 [28]; US | Education and income (Individual and household) | Highest level of parental education in household (less than HS, HS diploma, GED, some college, college degree) Poverty ratios for 2010: below federal threshold (less than 1.0, 1 to < 2 times threshold, 2 to < 4 times threshold, 4 times or more threshold) | Sociodemographic and health status | National Health Interview Survey; National survey (2009–10) | Positive association. Children of parents whose highest level of education was HS or GED (0.82ARR, 0.68–1.0CI) or less than a HS diploma (0.72ARR, 0.57–0.92) were less likely to be vaccinated compared to those with parents who had some post-secondary education. Children living 4 times or more above the poverty threshold were more likely to be vaccinated compared to those living less than 1 times below (0.75ARR, 0.59–0.96CI), 1 to < 2 times below (0.69ARR, 0.57–0.84CI), 2 to < 4 times below (0.77ARR, 0.66–0.90CI). There was no association between education and income and receipt of a second pH1N1 vaccination. |
CDC 2013 [29]; US | Education and income (Individual and household) | Level of education (less than 12 years, 12 years, more than 12 years) Federal poverty level for 2010 (at or below the poverty level, above the poverty level) | None reported | Massachusetts Pregnancy Risk Assessment Monitoring System; State survey (2009–10) | Positive association. Pregnant women with less than 12 years (56.6%, 45.0–67.5CI) of education had lower seasonal vaccination rates compared to those with 12 years (63.1%, 54.4–71.1CI) or greater than 12 years education (71.1%, 66.0–75.5CI). No association was found with pH1N1 vaccine. Pregnant women living above the federal poverty line had greater coverage of seasonal influenza vaccination (70.5%, 65.6–75.0CI) compared to those living at or below it (56.1%, 47.5–64.3%), but no association was found for pH1N1. |
Dlugacz 2012 [30]; US | Education and income (Individual) | Education level (less than HS, HS, college graduate, graduate degree) Income level ($75,000 or more, $50,000–$75,000, less than $50,000) | Sociodemographic variables | Survey of postpartum women on labour and delivery service; Survey administered in 4 hospitals in Nassau County New York, and Queens County in New York City (2010) | Positive association. In the unadjusted model, each increase in level of education among postpartum women resulted in higher levels of vaccination. For income levels, the highest income group was twice as likely to have been vaccinated than the middle and low-income group. The adjusted ORs were not reported for income and education separately. When looking at the combined effects of income and education, higher levels resulted in 43–69% of pregnant women receiving a vaccine when recommended by a healthcare provider, compared to 4–10% when not recommended. |
Gorska-Ciebiada 2015 [31]; Poland | Education and income (Individual) | High (above 2000 pln) or low income (2000 pln or lower) Education level (primary, secondary, technical, university) | Sociodemographic, health status, and clinical variables | Survey of elders in an internal medicine and diabetology outpatient clinic in Lodz; Survey of clinic outpatients (2012–13) | Mixed findings. Elderly outpatients with diabetes aged 65 and older were more likely to be vaccinated if they had higher income (5.34OR, 2.38–12.16CI). |
Hellfritzsch 2017 [32]; Denmark | Education and income (Individual and household) | Education level, in years beyond primary school (none, less than 3 years, 3–4 years, more than 4 years, other) Annual household income in Danish Kroner (less than $99,000, $100,000–$149,000, $150,000–$249,000, $250,000–$374,999, $375,000–$524,000, more than $524,000) | Age and sex | Questionnaire from Centre for Public Health; National survey (2006) | Mixed findings. There was no association between seasonal influenza vaccination and education level among Danes ages 65–79. For income, only the middle-income group (1.10PR, 1.00–1.21CI) was associated with seasonal influenza vaccination after controlling for age and sex. |
Hoeck 2013 [33]; Belgium | Education and income (Household) | Highest level of education (no degree or primary education, lower secondary, higher secondary, higher education) Household income (<€750, €750–€1000, €1000–€1500, €1500–€2500, and > €2500) | Sociodemographic variables, health status, and risk factors | Belgian Health Interview Survey; National survey (2004; 2008) | No association. There was no significant association between level of education or household income with influenza vaccination. |
Kwon 2016 [34]; South Korea | Education and income (Individual and household) | Education level: low (less than 6 years) or high (more than elementary school) Household income (less than $1000 USD per month, or $1000 USD or more per month) | Sociodemographic variables, health status, and behavioural risk factor variables | Korean National Health and Nutrition Examination Survey; National survey (2007–09) | Mixed findings. Higher education was associated with higher levels of vaccination (1.27OR, 1.03–1.57CI) among the elderly 65 and older. No association with income was found. |
Lee 2015 [35]; South Korea | Education and income (Individual and household) | Education level: low (elementary), middle (middle or high school), high (college or higher) Household income (low [Q1), middle [Q2, Q3], high [Q4]) | Sociodemographic factors and health status variables | Korea National Health and Nutrition Examination Survey; National survey (2010–11) | Mixed findings. No significant relationship was found between influenza vaccination and education for any age group. Younger adults aged 19–50 years were less likely to be vaccinated if they were in the highest income group (0.33OR, 0.26–0.40CI), compared to the lowest. For adults age 50 or older, no significant association was found. |
Lee 2012 [36]; US | Education and income (Individual) | Education level (none, 5 years or less, more than 5 years) Income ($50,000 or less, more than $50,000) | Sociodemographic variables, health status variables, education in the US and acculturation level | Survey of Korean-Americans; Nationally representative survey (2005–07) | No association. No significant associations were found between education or income and influenza vaccination among adult Korean women living in California. |
Lu 2012 [37]; US | Education and income (Individual) | Education level (less than HS, HS graduate, college) Income (below $20,000, $20,000-50,000, $50,000 or higher) | Sociodemographic factors, health status variables, and insurance status | Behavioral Risk Factor Surveillance System; National survey (2009–10) | Positive association. Among healthcare personnel, adults were more likely to be vaccinated against H1N1 or seasonal influenza if they had incomes above $50,000. For non-healthcare personnel, only seasonal influenza vaccination was associated with higher income levels. For education, significant and positive associations were found for H1N1 and seasonal influenza vaccinations, whereby the highest education group had the highest proportion of vaccine. |
Lu 2016 [38]; US | Education and poverty (Individual) | Education level (HS or less, some college or college graduate, above college graduate) Poverty level (at or above poverty, below poverty) | Sociodemographic variables and health status variables | National Health Information Survey; National survey (2013; 2014) | Mixed findings. Healthcare personnel with college education were significantly more likely to have received influenza vaccination compared to those with high school or less (1.27 PR, 1.11–1.46 CI). There was no relationship found with poverty and vaccination status for healthcare personnel. For non-healthcare personnel, any level of education higher than high school was significantly associated with vaccination. (College level compared to high school or less was 1.10 PR, 1.06–1,15 CI; above college 1.34 PR, 1.26–1.42 CI). Non-healthcare personnel were more likely to be vaccinated if they were at or above the poverty level (1.08 PR, 1.02–1.14 CI) compared to those below it. |
Schuller 2013 [39]; US | Education and poverty (Individual) | Mother’s education level (college graduate less than 12 years, 12 years, more than 12 years, non-college graduate) Poverty status (above poverty level with $75,000 or more, or below poverty level) | Sociodemographic variables | National Immunization Survey; National survey (2008–09) | Positive association. Mothers who graduated from college were more likely to vaccinate their children compared to mothers with a high school degree (0.57OR, 0.51 to 0.63 CI). Mothers who lived above the poverty level with incomes of $75,000 or more were significantly more likely to vaccinate their children compared to those who lived above the poverty level with lower levels of income (0.64 OR, 0.58 to 0.71 CI) or below it (0.63 OR, 0.56 to 0.71 CI). |
Takayama 2012 [40]; US | Education and income (Individual) | Education (less than HS, more than HS) Annual income (less than $35,000, more than $35,000) | Sociodemographic variables, health behavior variables, and physical health status | Behavioral Risk Factor Surveillance System; National survey (2009) | Positive association. Among elderly adults 60 years and older, having less than a high school education was significantly associated with lower levels of vaccination (0.95 OR, 0.92 to 0.99 CI). For older adults and adults aged 16 to 64 years, lower income was significantly associated with lower levels of vaccination. |
Zhai 2017 [41]; US | Education and poverty (Individual) | Mothers education level (less than 12 years school, 12 years of school, more than 12 years of school, not a college graduate) Poverty status (above poverty level with more than $75,000 per year, above the poverty level with less than $75,000 per year, at or below the poverty level) | Not reported | National Immunization Survey Flu (NIS-Flu); National survey of households with children aged 6 months to 17 years (2015) | Positive association. In 2012–2013, higher levels of mother’s education were significantly related to vaccination among children aged 6 months to 8 years, increasingly, for every level of education. In the 2013–2014 season, only having a college degree was significantly related to vaccination, while having 12 years of school was significantly less likely to be vaccinated. Poverty status was significantly related to higher levels of vaccination for children whose parents lived above the poverty line and made more than $75,000 per year, compared to those living with lower incomes in both seasons. |
Income and poverty (n = 1; 1 mixed findings) | |||||
Muscoplat 2013 [42]; US | Income and poverty (Neighbourhood) | Percentage of residents in a ZIP code with incomes below the federal poverty level (<$35,000; $35,000 to <$40,000; $40,000 to $50,000; >$50,000) Percentage of residents with incomes below the poverty level (< 3.0%; 3.0 to < 5.0%; 5.0 to 8.0%; > 8.0%) | Poverty and minority status | Minnesota Immunization Information Connection; Immunization database (2009–10) | Mixed findings. There were significant differences in H1N1 vaccination rates when comparing percentage of residents living below the poverty line. The results show that generally, areas where there were greater proportions of persons living below the poverty line (5 to 8%, or 8% and higher) had higher vaccination rates than in areas where there were lower proportions (3 to < 5%, less than 3%). Median family income was significantly related to vaccination rates. In areas with higher vaccination rates (20% and above), higher income was associated with higher vaccination levels. In areas where vaccine rates were less than 20%, lower income levels were associated with higher levels of vaccination. |
Study; Country | SES Concept (Level of SES measure) | Description SES measure | Adjusted mediating factorsa | Data source; Data type (Year collected) | Results |
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Education, Income, and Occupational Class measured separately (n = 6; 5 mixed findings, 1 negative association) | |||||
Der-Martirosian 2013 [43]; US | Education and employment (Individual) | Level of education (<HS, HS, some college, college graduate) Income ($15,000–$35,000; $35,000 or above) Employment status (employed, unemployed) | Sociodemographic variables, source of care, and veteran status | National Health Interview Survey; National survey (2010) | Mixed findings. Adults had greater odds of H1N1 vaccination where they had some college (1.29OR, 1.07–1.55CI) or graduated college (1.80OR, 1.49–2.19CI), compared to persons with less than high school; only college graduation was associated with seasonal influenza vaccination (1.58OR, 1.34–1.86CI). Higher income was positively associated (1.24OR, 1.11–1.40CI) only with seasonal influenza vaccination. Employment status was not associated with either H1N1 or seasonal influenza vaccination. |
Laenen 2015 [44]; Belgium | Education, employment, and income (Individual and household) | Education: lower (no HS diploma), HS diploma, higher (beyond HS) Family income: less than 1500 euros, 1500–3000 euros, more than 3000 euros Work situation: fulltime, part-time, no job | None reported | Survey, clinical, and administrative data; Questionnaire, medical charts, and registry data from University Hospitals in Leuven (2013–14) | Mixed findings. Income or work situation did not influence vaccine coverage. Higher education pregnant women were more likely (2.73OR, 1.46–5.29CI) to be vaccinated than those with secondary school. |
Liu 2012 [45]; Canada | Neighbourhood level of education, income, and employment (Neighbourhood) | Level 1 (lowest) to 5 (highest) assigned to neighbourhoods based on linked postal code records with Census data for highest level of education, median family income, and employment income | Sociodemographic variables, health status variables, clinical variables related to pregnancy, and neighbourhood-level characteristics | Better Outcomes Registry & Network; Birth records database (2009–10) | Mixed findings. Women who gave birth in an Ontario hospital with the highest level of education and the highest level of income were more likely to receive influenza vaccination compared to women from lower levels. Employment level was not significantly associated with vaccination. |
Shin 2012 [46]; Korea | Education, employment, income (Individual) | Education (HS and above, less than high school) Employment (employed or unemployed) Monthly income (equal to or more than 2 million KRW, less than 2 million KRW) | Sociodemographic variables, health status variables, cancer variables, and vaccine knowledge and beliefs variables | Korean National Cancer Centre Survey; Nationwide survey (July – October 2010) | Mixed findings. Among cancer patients age 18 years and older, higher vaccination rates were associated with higher levels of education (1.72 OR, 1.02–2.93 CI). |
Shono 2015 [47]; Japan | Education, employment, income (Individual) | Schooling years of the respondent Annual household income quintile Mother’s employment (Unemployed, employed) | Sociodemographic variables and vaccination recommendation | Survey of Japanese parents with at least one child under 13 years of age; Survey conducted for study purposes (2013) | Mixed findings. After controlling for sociodemographic variables and vaccination recommendation from a physician, the only significant relationship found was between the second-highest income quintile compared to the lowest (0.64 beta coefficient, 0.07 to 1.20 CI). |
Yang 2014 [48]; Korea | Education, income, and occupational class (Individual) | Education (less than HS, HS or more) Monthly income (2 million KRW or more, less than 2 million KRW) Occupational class (professional, service/manual worker, others) | Sociodemographic variables | Korean Community Health Survey; Nationwide survey (2008–2012) | Negative association. Across all seasons, lower levels of income, working in service or physical occupations, and lower levels of education were significantly associated with higher levels of vaccination among Korean adults. |
Socioeconomic status, as a composite measure (n = 3; 2 positive association, 1 no association) | |||||
Bohmer 2012 [49]; Germany | Socioeconomic status (Individual) | High, medium, or low (determined based on education, income, and professional education) | Sociodemographic and health status variables | Germany Health Update; National survey (2009–10) | Positive association. High SES adults were more likely (1.61OR, 1.23–2.11CI) to be vaccinated against pandemic influenza compared to low SES adults. |
Maher 2013 [50]; Australia | Socio-economic index summarizing information about the economic and social conditions of people and households within an area (Neighbourhood) | Index of Relative Socio-economic Disadvantage | Sociodemograhpic and antenatal care experience variables | Survey of women who delivered a baby in public hospitals; South Western Sydney and Sydney local health districts (2012) | No association. There was no significant association between level of SES disadvantage and influenza vaccination after adjusting for sociodemographic and antenatal care variables. |
Schwartz 2013 [51]; Israel | Socioeconomic status (Neighbourhood) | Defined by the income quartile assigned by the zip code of the patient’s residence, using census data (High SES = 4, low SES = 1) | Sociodemographic variables, primary care variables, and comorbidities | Data from Maccabi Health Services; Maccabi Health Services (2004–09) | Positive association. There was a positive stepwise relationship between SES status and influenza vaccination status, whereby persons in high SES at Level 4 SES (ref) were more likely to be vaccinated compared to Levels 3 (0.82 OR, 0.79–0.85 CI), 2 (0.74OR, 0.71–0.77 CI), or 1 (0.72 OR, 0.68–0.77 CI) among the elderly aged 65 years and older. |
Deprivation index (n = 3; 3 positive association) | |||||
Brien 2012 [52]; Canada | Material and social deprivation (Neighbourhood) | Deprivation quintile (1 = low to 5 = high) derived from Pamplaon and Raymond’s index of material and social deprivation | Sociodemographic and clinical variables | Immunization records from National Public Health Institute of Quebec; Administrative data (2009) | Positive association. There were lower levels of vaccination in neighbourhoods with higher levels of material deprivation (per unit increase, approximately 7, 15, and 17% decrease in odds). No association was found between social deprivation and neighbourhood-level vaccination rates. |
Calder 2014 [53]; New Zealand | Socioeconomic deprivation (Neighbourhood) | Level of socioeconomic deprivation, measured by NZDep 2006 quintile (1 = low, 5 = high deprivation) | None reported | Data from the patient management system of primary health organizations; Administrative data (2012–13) | Positive association. Vaccination among children improved after introducing a school vaccination programme. Vaccination was lowest in the most deprived quintiles (Dep1 = 30.2%, Dep2 = 29.2%, Dep3 = 36.6%, Dep4 = 24.3%, Dep5 = 21.9%) |
Green 2015 [54]; England | Multiple deprivation (Neighbourhood) | Overall score assigned to each census lower super output area level summarizing relative deprivation based on: income, employment, health, education, crime, service, access, and living environment. Higher score = higher deprivation. | Population-level characteristics (e.g., sociodemographic, rural/urban classification) | Clinical and program data; 2–3 yr. olds: data collected from GP practices through ImmForm 4–11 yr. olds: data collected at schools from each of 6 pilot sites (2013–14) | Positive association. Children ages 4–11 were significantly less likely to be vaccinated in the two areas of highest deprivation, with scores of 26.1 to 39.9 (− 5.55 SC, − 9.54 to − 1.56CI) or 39.9+ (− 7.9 SC, − 12.16 to − 3.64 CI). |