Which factors make a difference when identifying pockets of under-immunization? Gayle Moxness Hennepin County Community Health Department Minneapolis,

Which factors make a difference when

identifying pockets of

under-immunization? Gayle Moxness

Hennepin County Community Health DepartmentMinneapolis, MN

October 2002

Agenda

Identify Sources and Tools Plan the Analysis Analyze the Data -

Look for Patterns/Relationships See the Results -

Hennepin County Analysis

Identify Sources/Tools

ImmuLink Immunization Registry

2000 Census Data

CASA (Clinic Assessment Software Application)

GIS (Geographic Information System)

What is ImmuLink?

Immunization Registry serving

the Minneapolis/St. Paul Metro Region (population 2.6 million)

History Behind ImmuLink

Retrospective studies• Conducted by the Minnesota Department of

Health • Identified pockets within Hennepin County

that had very low immunization rates ImmuLink launched in 1995

• Hennepin County launched ImmuLink in response to these research results

ImmuLink Today

Nearly 600,000 records (people of all ages with shots)

Over 4 million shots

111 Participating Sites (public and private clinics, including large clinic systems, and schools)

Plan the Analysis

Focus on Hennepin County

Develop hypotheses

Determine geographic areas

Analyze the data

Focus on Hennepin County, MN

Minneapolis and Suburbs

Population: 1.1 million

Increasingly diverse

Develop Hypotheses: Do any of these factors relate to

immunization UTD rates?

Poverty level Inability to speak English well Gender Race/ethnicity Immigrant density Population density Single parent household

Possible Geographic Areas

Urban/Suburban Cities (47 in Hennepin County)

Communities/Planning Districts (11 in Minneapolis)

Neighborhoods (34 in Minneapolis)

Census Tract (298 in Minneapolis)

Zip Code

Analyze the DataExtract Data from ImmuLink

From ImmuLink, extract immunization data for children who:

Live in Hennepin CountyAre 24-35 months old

For each child:Vaccinations given/datesStreet addressGender (if available)Race (if available)

Result: 7023 records

Analyze the Data

Match Addresses Match children’s addresses from ImmuLink with

defined Census geographic areas

Test for sufficient sample size

Result: • “Communities” for Minneapolis• “Cities” for suburban areas

-

Analyze the DataCASA

Use CASA to analyze ImmuLink data to determine UTD rates

Total Hennepin County- Gender- Race

Each geographic area

Analyze the Data

Census Analyze Census 2000 data by

geographic area:• Population density, poverty, etc.• Above/below County average

Integrate with CASA analysis• Look for patterns: UTD rates and Census

Hennepin County Analysis Census and UTD Rates

Calculate indices to easily compare above/below the County average for different types of data Example: • If Hennepin County has average HH income of $30,000 per year• City XYZ has an average HH income of $60,000• We see that the city has above average income City XYZ = 60,000 = 200% (index County 30,000 of 200)

Hennepin County Analysis Total Hennepin County

Does Gender make a difference?

6,926 kids had a “gender” code in ImmuLink (only 97 records without gender code)

Compare UTD rates for M & F

Is the rate for one gender above average, the other below average?

Hennepin County AnalysisHennepin County ImmuLink Data

Index to County Avg.%UTD* (49.8%=100)

Female 49.8 100 Male 50.4 101

*includes MOGEs

Conclusion: Gender doesn’t make

a difference

Hennepin County AnalysisHennepin County ImmuLink Data

Does race make a difference?

2486 kids with “race” code in ImmuLink

( Nearly 2/3 of all records lack the optional “race”code)

Compare UTD rates for differentracial groups

Hennepin County Analysis Hennepin County ImmuLink Data

Index to County Avg. %UTD (49.8%=100)

White 36.2 73Black 45.8 92Asian 41.7 84Am. Indian 42.5 85No race code 55.3 111

Results: Inconclusive. Questionable whether samples represent

each racial group since all groups are below the County average


Does Suburban versus Urban make a difference?

Suburban Cities combined Minneapolis Communities combined

Hennepin County Analysis Suburbs vs. Minneapolis (ImmuLink and Census Data)

0

50

100

150

200

250

Suburban Minneapolis

Ind

ex t

o H

enn

epin

Co

un

ty A

vg (

=10

0)

4-3-1 UTD

White

Black

Am. Indian

Asian

County Average =100

Hennepin County Analysis Suburbs vs. Minneapolis (ImmuLink and Census Data)

0

50

100

150

200

250

Suburban Minneapolis

Ind

ex t

o H

enn

epin

Co

un

ty A

vg (

=100

)

4-3-1 UTD

Population Density

Poverty 200%

Single Parent HH

Foreign Born

Poor English Skills

County Average=100


Minneapolis Communities Combined•Greater population density•Greater poverty, etc.•And, higher UTD rate

Look at each geographic area•Minneapolis Communities•Suburban Cities

Hennepin County Analysis Minneapolis Communities (ImmuLink and Census Data)

0

50

100

150

200

250

300

350

Ind

ex

to

He

nn

ep

in C

ou

nty

Av

g (

=1

00

)

4-3-1 UTD

Poverty 200%

County Average

Hennepin County Analysis Minneapolis Communities (ImmuLink and Census Data)

0

50

100

150

200

250

300

350

400

450

500

Ind

ex

to

He

nn

ep

in C

ou

nty

Av

g (

10

0)

4-3-1 UTDPoor English skills

County Average


Minneapolis Communities: Inverse relationship with UTD rates

•Poverty (As poverty increases, UTD rate decreases)

•Poor English-speaking skills•Continue analysis for other factors

Look at Suburban Cities

Hennepin County Analysis Suburban Cities (ImmuLink and Census Data)

0

20

40

60

80

100

120

Gold

en V

alley

Plymou

th

Hopkin

s

Edina

Minn

eton

ka

Map

le G

rove

St. Lo

uis P

ark

Richfie

ld

Eden

Prairi

e

New H

ope

Robbin

sdale

Bloom

ingt

on

Brook

lyn P

ark

Crysta

l

Brook

lyn C

ente

rInd

ex t

o H

enn

epin

Co

un

ty A

vg (

=10

0)

4-3-1 UTD

Poverty 200%

County Average

Hennepin County Analysis Suburban Cities (ImmuLink and Census Data)

0

20

40

60

80

100

120

Ind

ex

to

He

nn

ep

in C

ou

nty

Av

g (

=1

00

)

4-3-1 UTDPoor English skills

County Average


Suburban CitiesUTD rates and other factors don’t show expected relationships

Do further analysis with GIS

Hennepin County AnalysisGIS

Use GISUTD Rates by geographic area

24-35 month olds in ImmuLink as a percent of population

Different assumptions

Maple Grove

MinnetonkaBeach

GreenwoodTonka Bay

Osseo

Robbins-dale

Fort SnellingChanhassen

Medicine Lake

Rockford

Loretto

SpringPark

Woodland

ExcelsiorSt. Bonifacius

Long Lake

Maple Plain

St.Anthony

Deephaven

Hanover

Wayzata

New Hope

Hopkins

Brooklyn Center

Rogers

Mound

Golden Valley

St. Louis Park

Richfield

Crystal

Champlin

Shorewood

Brooklyn Park

Greenfield

Minnetonka

Independence

Edina

Eden Prairie

Minnetrista

Bloomington

HassanDayton

MedinaPlymouth

Corcoran

Orono

Minneapolis

NokomisSouthwest

Northeast

Camden

University

Longfellow

Central

Near-North

Calhoun-Isles

Powderhorn

Phillips

Immunizations Percent Up-To-DateAmong 24-35 Month Old Children,

as of September 1, 2002

Hennepin County

2 0 2 4 Miles

N

EW

S

Source: Hennepin County Community Health Department, ImmuLinkPrepared by: Hennepin County Community Health Department, 10/23/2002il_registry-conference.apr

Data Aggregated and Displayed byHennepin County City and Minneapolis Community

City boundariesMpls Community boundaries

Percentage of Children in ImmuLinkAge 24-35 Months WhoseImmunizations Are Up To Date

19% - 32%33% - 45%46% - 57%58% - 66%Insufficient data to calculate rate

NokomisSouthwest

Northeast

Camden

University

Longfellow

Central

Near-North

Calhoun-Isles

Powderhorn

Phillips

Maple Grove

MinnetonkaBeach

GreenwoodTonka Bay

Osseo

Robbins-dale


Medicine Lake

Rockford

Loretto

SpringPark

Woodland


Long Lake

Maple Plain

St.Anthony

Deephaven

Hanover

Wayzata

New Hope

Hopkins

Brooklyn Center

Rogers

Mound

Golden Valley

St. Louis Park

Richfield

Crystal

Champlin

Shorewood

Brooklyn Park

Greenfield

Minnetonka

Independence

Edina

Eden Prairie

Minnetrista

Bloomington

HassanDayton

MedinaPlymouth

Corcoran

Orono

Minneapolis

Data Aggregated and Displayed byHennepin County City and Minneapolis Community

il_registry-conference.apr

Source: U.S. Census, 2000: Hennepin County Community Health Department, ImmuLinkPrepared by: Hennepin County Community Health Department, 10/23/2002

N

EW

S

2 0 2 4 Miles

Hennepin County

ImmuLink Children Age 24-35 Months(September 1, 2002) as a Percentageof All Children 24-35 Months of Age

(U.S. Census, April 2000)

ImmuLink 2 Year Oldsas a Percentage of All 2 Year Olds

3% - 25%26% - 50%51% - 75%76% - 90%> 90%Insufficient data to calculate rate

City boundariesMpls Community boundaries


Minneapolis Communities• Highest UTD Rates• Highest percent of population represented in

ImmuLink

Look at “High end” and “Low end” Assumptions


Look at “High end” and “Low end” Assumptions

• High end: Assumes that all children not in ImmuLink ARE Up-To-Date

• Low end: Assumes that all children not in ImmuLink are NOT Up-To-Date

NokomisSouthwest

Northeast

Camden

University

Longfellow

Central

Near-North

Calhoun-Isles

Powderhorn

Phillips

Maple Grove

MinnetonkaBeach

GreenwoodTonka Bay

Osseo

Robbins-dale


Medicine Lake

Rockford

Loretto

SpringPark

Woodland


Long Lake

Maple Plain

St.Anthony

Deephaven

Hanover

Wayzata

New Hope

Hopkins

Brooklyn Center

Rogers

Mound

Golden Valley

St. Louis Park

Richfield

Crystal

Champlin

Shorewood

Brooklyn Park

Greenfield

Minnetonka

Independence

Edina

Eden Prairie

Minnetrista

Bloomington

HassanDayton

MedinaPlymouth

Corcoran

Orono

Minneapolis

NokomisSouthwest

Northeast

Camden

University

Longfellow

Central

Near-North

Calhoun-Isles

Powderhorn

Phillips

Maple Grove

MinnetonkaBeach

GreenwoodTonka Bay

Osseo

Robbins-dale


Medicine Lake

Rockford

Loretto

SpringPark

Woodland


Long Lake

Maple Plain

St.Anthony

Deephaven

Hanover

Wayzata

New Hope

Hopkins

Brooklyn Center

Rogers

Mound

Golden Valley

St. Louis Park

Richfield

Crystal

Champlin

Shorewood

Brooklyn Park

Greenfield

Minnetonka

Independence

Edina

Eden Prairie

Minnetrista

Bloomington

HassanDayton

MedinaPlymouth

Corcoran

Orono

Minneapolis

High End (Assumes that All ChildrenWho Are Not In ImmuLink ARE

Up To Date With Immunizations)

Low End (Assumes that All ChildrenWho Are Not In ImmuLink Are NOTUp To Date With Immunizations)

(Potential) Range of Immunization Up To Date Percentages in the Population of ChildrenAge 24-35 Months, Based on ImmuLink Up To Date Records (as of September 1, 2002)

Hennepin County

2 0 2 4 Miles

N

EW

S

Source: U.S. Census, 2000; Hennepin County Community Health Department, ImmuLinkPrepared by: Hennepin County Community Health Department, 10/23/2002il_registry-conference.apr

(Potential) Percentageof Children Age 24-35Months WhoseImmunizations areUp To Date

0% - 25%26% - 50%51% - 75%76% - 90%91% - 97%Insufficient datato calculate rate

City boundaries

Mpls Communityboundaries

Data Aggregated and Displayed by Hennepin County City and Minneapolis Community


Dramatic differences in the picture depending on assumptions

Retrospective Survey Results show “High End” closer to reality


When registry penetration is high, as in Minneapolis, analysis of patterns is more reliable

When registry penetration is low, analysis is less reliable


Strong ImmuLink expansion in metro area continues

Additional Factors at Work

•Successful Outreach Program-Baby Tracks


Baby Tracks - Outreach Program

•Focuses on high risk 0-2 year olds in 23 zip codes in Minneapolis and inner ring suburbs

•Personal reminders and incentives to parents to immunize their children

ConclusionsHow to identify pockets of under-immunization

Integrate your sources/tools • ImmuLink Registry

• 2000 Census Data

• CASA

• GIS

Analyze data for patterns Consider level of registry penetration Look further, e.g. targeted programs

Documents

Which factors make a difference when identifying pockets of under-immunization? Gayle Moxness Hennepin County Community Health Department Minneapolis,