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The Netherlands has experienced epidemics of vaccine preventable diseases largely confined to the Bible belt, an area where -among others- orthodox protestant groups are living. Lacking information on the vaccination coverage in this minority, and its various subgroups, control of vaccine-preventable diseases is focused on the geographical area of the Bible belt. However, the adequacy of this strategy is questionable. Wilhelmina LM Ruijs, of the Academic Collaborative Centre at Radboud University in The Netherlands, and colleagues assessed the influence of presence of various orthodox protestant subgroups (orthodox protestant denominations, or OPDs) on municipal vaccination coverage in the Bible belt. Their research was published in BMC Public Health.
The researchers performed an ecological study at municipality level. Data on number of inhabitants, urbanization level, socio-economical status, immigration and vaccination coverage were obtained from national databases. As religion is not registered in the Netherlands, membership numbers of the OPDs had to be obtained from church year books and via church offices. For all municipalities in the Netherlands, the effect of presence or absence of OPDs on vaccination coverage was assessed by comparing mean vaccination coverage. For municipalities where OPDs were present, the effect of each of them (measured as membership ratio, the number of members proportional to total number of inhabitants) on vaccination coverage was assessed by bivariate correlation and multiple regression analysis in a model containing the determinants immigration, socio-economical status and urbanization as well.
The researchers report mean vaccination coverage (93.5% +/- 4.7) in municipalities with OPDs (n=135) was significantly lower (p <0.001) than in 297 municipalities without OPDs (96.9% +/- 2.1). Multiple regression analyses showed that in municipalities with OPDs 84 percent of the variance in vaccination coverage was explained by the presence of these OPDs. Immigration had a significant, but small explanatory effect. Membership ratios of all OPDs were negatively related to vaccination coverage; this relationship was strongest for two very conservative OPDs.
As variance in municipal vaccination coverage in the Bible belt is largely explained by membership ratios of the various OPDs, control of vaccine-preventable diseases should be focused on these specific risk groups, the researchers conclude. In current policy, part of the orthodox protestant risk group is missed, they add.
Reference: Ruijs WLM, Hautvast JLA, van der Velden K, e Vos S, Knippenberg H and Hulscher MEJL. Religious subgroups influencing vaccination coverage in the Dutch Bible belt: an ecological study. BMC Public Health 2011, 11:102doi:10.1186/1471-2458-11-102.