Socioeconomic inequality in recommended childhood vaccinations in Germany: evidence from insurance claims and concentration index decomposition.
Childhood vaccination completion in Germany is slightly higher among higher-income households
Socioeconomic inequality in recommended childhood vaccinations in Germany: evidence from insurance claims and concentration index decomposition.
Despite well-established childhood immunization programs in many high-income countries, vaccination series are often delayed or not completed.
We aimed to assess the extent of these gaps in Germany, as well as the presence of socioeconomic inequality and the factors accounting for it.
Using health insurance claims data from Techniker Krankenkasse for 2016-2019, we examined vaccination coverage for a comprehensive set of STIKO-recommended childhood vaccinations in six birth-year cohorts (2011-2018; approximately 430,000 children; 2.5 million recommended vaccinations).
vaccination completion runs slightly higher in higher-income households
Approximately 80% of vaccination series in the sample were complete and administered within the recommended age window.
In the decomposition analysis, provider type accounted for the largest share of this gradient, with lower completion rates and timeliness among children whose outpatient care was mainly delivered by general practitioners compared with pediatricians.
Parental education contributed to a lesser extent, and travel time contributed little to the observed inequality.
Childhood vaccination coverage in Germany remains below national targets and shows a small socioeconomic gradient.
The gradient appears to be less strongly related to logistical access barriers than to differences in how vaccinations are delivered in outpatient care outside pediatric settings.
These provider-type differences in vaccination delivery may therefore be more relevant for narrowing the observed gradient than further reductions in travel time.