Spatial inequities in childhood vaccination coverage in South Korea: A nationwide spatiotemporal analysis, 2017-2023

초록

Objectives: This study aimed to identify clusters of undervaccination and regional determinants in South Korea. Methods: We conducted an ecological spatiotemporal study of complete vaccination coverage among 3and 6-year-olds in all 250 municipalities from 2017 to 2023. Global Moran's I and Getis-Ord Gi* detected spatial autocorrelation and local hotspots with low coverage. Bayesian spatiotemporal models examined associations between municipal coverage and area-level variables. Results: Distinct geographical inequities in childhood vaccination were identified: from 2017 to 2022, low coverage for 3-year-olds clustered in parts of Seoul and southwestern regions, while hotspots for 6-year-olds were concentrated in the southwest and parts of Seoul during 2018-2020 and shifted across regions from 2021 to 2023. In Bayesian spatiotemporal models, municipalities with higher National Health Insurance premiums and a greater share of traditional Korean medicine institutions were associated with lower complete vaccination coverage. Conclusion: Even in a high-coverage and high-income setting, this study found significant spatial inequities in childhood vaccination. Regional pockets with low coverage are associated with complex socioeconomic and healthcare contexts. Thus, a universal vaccination strategy can overlook important local vulnerabilities. These findings highlight the need for targeted local interventions and sustained monitoring to ensure equitable vaccination coverage. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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