Sex, birth order and non‑National Immunization Program vaccination coverage among Chinese children
1
School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
Popul. Med. 2026;8(Supplement Supplement 1):A1347
ABSTRACT
INTRODUCTION:
China has implemented the universal three-child policies, resulting in the increase of multi-child families. Our study aims to examine the associations of sex and birth order with non-national immunization programs (non-NIP) vaccination coverage among children in China.
METHODS:
In this cross-sectional survey in China from July to October 2022, children aged 1-6 and their caregivers were face-to-face interviewed. Information on children’s vaccination records, sex, birth order, and other characteristics of children and their caregivers were collected. Five common non-NIP vaccines [Hemophilus influenza b (Hib), varicella, rotavirus, enterovirus 71 (EV71) and 13-valent pneumonia (PCV13) vaccines] were recorded, and children received three or more of these vaccines were defined as vaccinated.
RESULTS:
A total of 1609 children were included, 48.0% (n=773) were girls, 822 (51.1%) were first-born, 578 (35.9%) were second-born and 209 (13.0%) were third-born or later. The coverage of non-NIP vaccines varied by sex and birth order of children, ranging from 55.8% for the first-born boys to 32.5% for the third-born or later girls. A lower likelihood of non-NIP vaccination was observed in girls than in boys (PR: 0.91, 95% CI: 0.82-1.00), independent of the children’s age. Compared with the first-born children, the PRs for receiving non-NIP vaccines were 0.84 (0.76-0.93) and 0.74 (0.59-0.90) among the second-born and third-born or later counterparts. Children’s sex and birth order had joint effects on non-NIP vaccination, with the lowest PRs for non-NIP vaccination observed 0.63 (95% CI: 0.44-0.87) in the third-born or later girls (0.63, 95% CI: 0.44-0.87), compared to the first-born boys.
CONCLUSIONS:
Children’s sex and birth order were independently and jointly associated with non-NIP vaccination, with later born children and girls having significantly lower coverage. In the context of the universal three-child policy in China, efforts for promoting non-NIP vaccine equity should particularly consider the children’s sex and birth order.
China has implemented the universal three-child policies, resulting in the increase of multi-child families. Our study aims to examine the associations of sex and birth order with non-national immunization programs (non-NIP) vaccination coverage among children in China.
METHODS:
In this cross-sectional survey in China from July to October 2022, children aged 1-6 and their caregivers were face-to-face interviewed. Information on children’s vaccination records, sex, birth order, and other characteristics of children and their caregivers were collected. Five common non-NIP vaccines [Hemophilus influenza b (Hib), varicella, rotavirus, enterovirus 71 (EV71) and 13-valent pneumonia (PCV13) vaccines] were recorded, and children received three or more of these vaccines were defined as vaccinated.
RESULTS:
A total of 1609 children were included, 48.0% (n=773) were girls, 822 (51.1%) were first-born, 578 (35.9%) were second-born and 209 (13.0%) were third-born or later. The coverage of non-NIP vaccines varied by sex and birth order of children, ranging from 55.8% for the first-born boys to 32.5% for the third-born or later girls. A lower likelihood of non-NIP vaccination was observed in girls than in boys (PR: 0.91, 95% CI: 0.82-1.00), independent of the children’s age. Compared with the first-born children, the PRs for receiving non-NIP vaccines were 0.84 (0.76-0.93) and 0.74 (0.59-0.90) among the second-born and third-born or later counterparts. Children’s sex and birth order had joint effects on non-NIP vaccination, with the lowest PRs for non-NIP vaccination observed 0.63 (95% CI: 0.44-0.87) in the third-born or later girls (0.63, 95% CI: 0.44-0.87), compared to the first-born boys.
CONCLUSIONS:
Children’s sex and birth order were independently and jointly associated with non-NIP vaccination, with later born children and girls having significantly lower coverage. In the context of the universal three-child policy in China, efforts for promoting non-NIP vaccine equity should particularly consider the children’s sex and birth order.
| eISSN: | 2654-1459 |
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