Academic Journal
Institutional drivers of newborn hepatitis B vaccine disparities: A multi-hospital analysis in Washington, DC, 2017-2023.
| Τίτλος: | Institutional drivers of newborn hepatitis B vaccine disparities: A multi-hospital analysis in Washington, DC, 2017-2023. |
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| Συγγραφείς: | Leslie TF; Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA., Delamater PL; Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Abutaleb AO; Department of Surgery and Medicine, and Cancer Center, George Washington University, Washington, DC, USA., Yang YT; Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC, USA.; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.; Cancer Center, George Washington University, Washington, DC, USA. |
| Πηγή: | Human vaccines & immunotherapeutics [Hum Vaccin Immunother] 2026 Dec; Vol. 22 (1), pp. 2616952. Date of Electronic Publication: 2026 Feb 04. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Taylor & Francis Country of Publication: United States NLM ID: 101572652 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2164-554X (Electronic) Linking ISSN: 21645515 NLM ISO Abbreviation: Hum Vaccin Immunother Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2015- : Philadelphia, PA : Taylor & Francis Original Publication: Austin, Tex. : Landes Bioscience |
| Ιατρικοί όροι (MeSH): | Healthcare Disparities*/statistics & numerical data , Hepatitis B*/prevention & control , Hepatitis B Vaccines*/administration & dosage , Hospitals*/statistics & numerical data , Vaccination Coverage*/statistics & numerical data , Vaccination Refusal*/statistics & numerical data, Female ; Humans ; Infant, Newborn ; Male ; District of Columbia ; Retrospective Studies ; White ; Black or African American |
| Περίληψη: | Despite universal newborn hepatitis B vaccination recommendations, birth dose coverage remains suboptimal with persistent racial disparities. While individual-level factors are well-studied, institutional practices' role in vaccination outcomes remains poorly understood. We conducted a retrospective cohort study of 87,246 singleton births across eight Washington, DC hospitals from 2017-2023, using multilevel mixed-effects logistic regression to examine institutional disparities in vaccine refusal. Overall refusal rate was 6.7%, declining from 12.1% in 2017 to 3.5% in 2023. Hospital-specific rates varied dramatically, from near-zero to over 50%. Multilevel analysis revealed 31.1% of refusal variance was attributable to between-hospital and between-year differences, with stable hospital characteristics accounting for 71% of this contextual variance (22.1% of total) and temporal trends accounting for 29% (9.0% of total). Analysis of hospital-specific temporal trajectories revealed marked heterogeneity in response speed to the 2018 ACIP policy change: safety-net hospitals achieved target refusal rates within one year, while institutions with higher baseline refusal required 2-4 y. In contrast to national adult vaccination patterns where White individuals have higher coverage, White infants had lower refusal odds than Black infants after covariate adjustment, suggesting institutional practices may be associated with context-specific disparities that differ from broader population patterns. Sensitivity analyses confirmed robustness of findings. Substantial institutional variation in vaccination practices is associated with disparities beyond what would be expected from patient demographics alone, highlighting the need for system-level interventions targeting organizational factors to achieve equitable vaccination coverage. |
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| Contributed Indexing: | Keywords: Hepatitis B vaccine; birth dose vaccination; health disparities; institutional factors; multilevel analysis; policy implementation |
| Substance Nomenclature: | 0 (Hepatitis B Vaccines) |
| Entry Date(s): | Date Created: 20260204 Date Completed: 20260706 Latest Revision: 20260707 |
| Update Code: | 20260707 |
| PubMed Central ID: | PMC12885389 |
| DOI: | 10.1080/21645515.2026.2616952 |
| PMID: | 41635225 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2164-554X |
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| DOI: | 10.1080/21645515.2026.2616952 |