Social Determinants of Health and their Influence on the Homogeneity of Vaccination Coverage in Paraíba

Abstract

Immunization is responsible for reducing infant morbidity and mortality. In Brazil, the National Immunization Program uses the Homogeneity of Vaccination Coverage (HVC) as a health indicator to determine whether vaccination coverage is homogeneous within a demographic space. Therefore, this study aims to analyze the spatial distribution of HVC in municipalities of Paraíba and relate it to the social determinants of health. This is a mixed ecological study design, where the data used are secondary and publicly available. HVC was the dependent variable, and the social determinants of health were the independent variables. To achieve the study’s objective, spatial analysis, Moran’s I Index, Local Spatial Association Index, logistic regression, and spatial regression were used. HVC was found to be heterogeneous throughout the state, with the formation of pockets of susceptibles. Prenatal coverage (OR 0.572; 95% CI 0.409-0.799; p<0.001) was positively associated with adequate HVC. The proportion of individuals with inadequate water and sewage networks (OR 1.345; CI 1.007-1.796; p=0.045) and the proportion of women as heads of households (OR 1.512; CI 1.082-2.113; p=0.015) are negatively associated with adequate HVC. Our study highlights the importance of identifying geographic areas with susceptible individuals and the factors that individually and collectively interfere with HVC, as this enables the development of intervention plans and the implementation of more targeted and efficient actions, ensuring resolvability.