Uncovering Gaps in Childhood Vaccine Coverage: A Post–COVID-19 Analysis of Vaccine Disparities in Tennessee

PurposeTo examine the association between sociodemographic determinants and parent-reported up-to-date childhood vaccination status in Tennessee.DesignCross-sectional statewide survey.SettingAll 95 Tennessee counties, July 2022 to May 2024. Surveys were distributed at community outreach events (health fairs, Head Start programs, community baby showers), and community organizations (schools, daycares, and preschools).SampleParents or caregivers of children aged 18 years and younger (N = 8954).MeasuresThe primary outcome was parent-reported up-to-date childhood vaccination status. Covariates included child's age, health insurance status, parental race/ethnicity and education, household income, and rural/urban residency.AnalysisDescriptive statistics and log-binomial regression models were used to assess associations between sociodemographic factors and vaccination status. Stratified analyses were conducted by rural and urban status. Adjusted prevalence (aP) and 95% confidence intervals (CIs) with robust estimates were reported.ResultsOverall, 96.5% reported that their children were up-to-date on vaccinations. The lowest vaccination rates were observed among children of multiracial (86.4%), and Asian/Native Hawaiian/Pacific Islander (90.3%) parents. Children without health insurance had a significantly higher prevalence of under-vaccination (aP = 0.104; 95% CI, 0.079-0.137) compared to insured children (aP = 0.029; 95% CI, 0.025-0.033). Across both rural and urban areas, under-vaccination was significantly associated with insurance, race, and child age, while parental education was significant only in urban areas and household income only in rural areas.ConclusionsFindings highlight critical gaps in vaccine coverage tied to insurance, race, and age. Targeted outreach to underserved and low-education communities is needed to promote equity in childhood vaccination.