Childhood vaccination coverage and socioeconomic inequalities in the Northern region of Brazil

Abstract

ABSTRACT Objective: To evaluate the spatio-temporal variation of childhood immunobiological vaccine coverage in the municipalities of the Northern region of Brazil, comparing cross-sectional data from 2018 and 2022, and its association with socioeconomic and maternal variables. Methods: This is a comparative ecological study with coverage data for seven immunobiologicals in the municipalities of the Northern region for the years 2018 and 2022. Data were obtained from the Department of Informatics of the Unified Health System. Spatial analysis (global, bivariate, and local Moran’s Index) was used to verify the association between vaccine coverage and independent variables (GDP per capita, Brazilian Deprivation Index, maternal schooling, proportion of indigenous people, full-term births, and birth weight). Results: There was a widespread decline in vaccine coverage when comparing the two periods, except for the meningococcal C vaccine. Vaccination was positively associated with GDP per capita and maternal schooling, and negatively associated with the Deprivation Index, with these associations intensifying over the period. The spatial correlation between immunization and the proportion of the indigenous population, previously not significant, became strongly negative in 2022. Clusters of low immunization and socioeconomic vulnerability were identified mostly in the states of Pará and Amazonas, and clusters of high immunization and better indicators in Tocantins and Rondônia. Conclusion: The decline in childhood vaccination in the Northern region is a spatially structured phenomenon that reflects and deepens socioeconomic inequalities. The formation of vulnerability clusters, especially in areas near the Brazilian border, represents a risk for the re-emergence of vaccine-preventable diseases and demands territorially focused public health policies.