Predictors of childhood vaccination uptake and timeliness: a cross-sectional study in a diverse urban UK population.

Abstract

Vaccination is a cornerstone of childhood public health. However, uptake has declined across the UK, with urban, deprived, and ethnically diverse communities facing unique barriers, exacerbated by the COVID-19 pandemic. To identify socioeconomic and clinical predictors of incomplete and untimely childhood vaccination between 2010 and 2023. This was a cross-sectional study using electronic health records from 40 general practices in Lambeth, an ethnically diverse London borough. Routinely collected data for 37 912 children eligible for vaccines by age 5 years were analysed. Multivariable logistic regression assessed associations between predictors and (a) vaccination uptake and (b) timeliness, defined as receipt within 3 months of the scheduled age. Of eligible children, 61.0% (<i>N</i> = 23 119/37 912) were fully vaccinated; of these, 60.8% (<i>N</i> = 14 062/23 119) were vaccinated on time. Lower uptake was associated with deprivation (most versus least deprived: adjusted odds ratio [AOR] 0.66, 95% confidence interval (CI) = 0.51 to 0.84), born outside the UK versus UK born (AOR 0.10, 95% CI = 0.08 to 0.12), and ethnicities other than White British (for example, Black Caribbean: AOR 0.30, 95% CI = 0.25 to 0.36). Children with clinical comorbidities had higher uptake (for example primary care-managed comorbidity: AOR 1.58, 95% CI = 1.46 to 1.71). Timeliness patterns differed: among those vaccinated, children born outside the UK and those from African, Caribbean, and Mixed ethnic backgrounds had higher odds of timely vaccination. Different predictors for uptake and timeliness highlight the need for strategies addressing both access and timely delivery. Local data should inform targeted, place-based interventions. Culturally competent services, integrated into routine primary care and codesigned with communities, are recommended.