TY  - THES
ID  - pittir33462
UR  - http://d-scholarship-dev.library.pitt.edu/33462/
A1  - Chadwell, Scott
Y1  - 2017/12/14/
N2  - Background: Despite having one of the highest vaccination rates in the entire country, New York State has had a number of vaccine preventable disease related outbreaks since 2003, including measles and mumps.  There is now growing concern that there is spatial heterogeneity in vaccine coverage and geographic clustering of low vaccination areas. This paper examined spatial variation of measles, mumps, and rubella (MMR) vaccination rates among school districts in New York State and created a spatial model of sociodemographic variables. This has public health significance as identifying where there is spatial heterogeneity of vaccination coverage, is important for disease control, outbreak prevention, and potential eradication.
 
Methods: We examined the spatial heterogeneity of measles, mumps, and rubella vaccination among school districts in New York State. 2014-2015 data were collected from the New York State Department of Health (NYDH) and the Elementary and Secondary Information System (ElSi). Data processing, spatial analysis (global and local Moran?s I tests), and spatial regression was done in STATA 15.1. Maps were generated in QGIS 2.18.14.

Results: A global Moran?s I test revealed no different from random spatial variation among MMR vaccination rates (Moran?s I = 0.003; p = 0.341), however, some local autocorrelation presented among school districts. All but two (medical and religious exemptions) of the predictor variables were significant for spatial autocorrelation. The final spatial model included percent religious exemptions, percent medical exemptions, percent of students receiving free and reduced-priced lunch, and urban location. Percent religious and percent medical exemptions (p<0.001), along with percent of students receiving free and reduced priced lunch (p<0.001) were found to be significant predictors. Percent religious exemptions accounted for 41% of the variation in MMR vaccination rates. We found no clustering for school district-level MMR vaccination coverage in the overall New York State area. We found five districts with low vaccination coverage that had a significant Moran?s I value at the local level, indicating clustering.

Conclusions: Vaccination coverage in New York State is very high. There are no particular clusters of districts with low-MMR coverage in New York State, suggesting the absence of spatially driven determinants of vaccination coverage. Some school districts had coverage below the critical vaccination threshold, and should be a focus for New York State public health authorities.
PB  - University of Pittsburgh
KW  - Spatial heterogeneity
KW  -  MMR vaccination coverage
KW  -  New York
M1  - masteressay
TI  - Spatial heterogeneity of MMR vaccine coverage: 
New York State, 2014-2015
AV  - public
EP  - 30
ER  -