Maternal, Infant, and Hospital Level Factors Associated with Newborn Hepatitis B Vaccination – Kansas, 2009

BACKGROUND: The birth dose of hepatitis B vaccine (HBV) is a safe and effective method of protecting infants against hepatitis B virus, and is recommended for all infants prior to hospital discharge. The association between maternal, infant, and hospital level characteristics to HBV receipt prior to discharge among infants born in Kansas hospitals was assessed. 

METHODS: A retrospective cohort study was conducted using data from the 2009 Kansas birth registry and a 2009 hospital policy survey. Infants weighing <2,000 grams and those who were not born at a hospital were excluded from the analysis.  Bivariate associations between infant HBV receipt prior to hospital discharge with maternal and infant factors (maternal age, race, education, insurance, prenatal care, gender, plurality) and hospital level characteristics (hospital size, attending provider, urbanicity, written hospital vaccination policy) were conducted. Stepwise multivariable logistic regression analyses were performed to determine the associations between maternal, infant, and hospital characteristics with receipt of HBV.

RESULTS: A total of 42,512 infants were identified from the birth cohort, and 36,407 (86%) birth records were included in the analysis. Overall, 80.7% of infants had received HBV prior to discharge.  Receipt of infant HBV significantly declined with increasing maternal age (p < 0.001) and education (p < 0.001).  Lack of prenatal care (OR: 0.7, 95% CI: 0.5-0.9) and maternal Medicaid insurance (OR: 0.7, 95% CI: 0.6-0.7) were associated with nonreceipt of HBV.  Female infants were more likely (OR: 1.08, 95% CI: 1.03-1.14), and singleton births were twice as likely to receive HBV (OR: 2.0, 95% CI: 1.8-2.3). Presence of a vaccination policy had no impact on receipt of HBV; however, presence of a midwife birth attendant reduced the likelihood of receiving HBV (OR: 0.3, 95% CI: 0.2-0.3).  Infants born at rural hospitals (OR: 1.6, 95% CI: 1.4-1.7) were significantly more likely to receive HBV compared to urban; infants born at medium (OR: 3.0, 95% CI: 2.6-3.5) and large (OR: 1.7, 95% CI: 1.4-1.9) hospitals were more likely to receive HBV compared to smaller hospitals.

CONCLUSIONS: Our study indicates that maternal, infant, and hospital level characteristics are associated with infant receipt of HBV. Our findings show that disparities at the individual and hospital level exist in the administration of HBV.  Reducing disparities due to maternal factors through educational efforts and identifying factors in urban hospitals that could account for lower HBV coverage of infants could help ensure that eligible newborns receive HBV prior to discharge.