Spatial distribution and determinants of childhood vaccination refusal in the United States

Bokgyeong Kang, Sandra Goldlust, Elizabeth C. Lee, John Hughes, Shweta Bansal, Murali Haran

Research output: Contribution to journalArticlepeer-review


Parental refusal and delay of childhood vaccination has increased in recent years in the United States. This phenomenon challenges maintenance of herd immunity and increases the risk of outbreaks of vaccine-preventable diseases. We examine US county-level vaccine refusal for patients under five years of age collected during the period 2012–2015 from an administrative healthcare dataset. We model these data with a Bayesian zero-inflated negative binomial regression model to capture social and political processes that are associated with vaccine refusal, as well as factors that affect our measurement of vaccine refusal. Our work highlights fine-scale socio-demographic characteristics associated with vaccine refusal nationally, finds that spatial clustering in refusal can be explained by such factors, and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.

Original languageEnglish (US)
Pages (from-to)3189-3195
Number of pages7
Issue number20
StatePublished - May 11 2023

All Science Journal Classification (ASJC) codes

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


Dive into the research topics of 'Spatial distribution and determinants of childhood vaccination refusal in the United States'. Together they form a unique fingerprint.

Cite this