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Kevin J. Dombkowski, DrPH, MS, Paula M. Lantz, PhD, MS and Gary L. Freed, MD, MPH

Kevin Dombkowski and Gary Freed are with the Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor. Gary Freed and Paula Lantz are with the Department of Health Management and Policy, School of Public Health, University of Michigan.

Correspondence: Requests for reprints should be sent to Kevin Dombkowski, DrPH, University of Michigan Division of General Pediatrics, 300 N. Ingalls, Ann Arbor, MI 48109-0456 (e-mail: kjd{at}med.umich.edu).

Objectives. We examined the associations of having health insurance and having a usual source of medical care with age-appropriate childhood vaccination.

Methods. Simulations were conducted with multivariate logistic regression models and a nationally representative sample of children to assess the likelihood of age-appropriate vaccination.

Results. Simulated provision of health insurance and a usual source of medical care produced substantial increases in the likelihood of doses being received age-appropriately. Increases in the likelihood of a child’s being up to date were also observed, but these increases typically were smaller than for age-appropriate vaccination.

Conclusions. Changes in childhood vaccination status should be assessed in age-appropriate terms, because measures of "up to date" status may not capture the effects of immunization interventions.

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