The privilege paradox: Geographic areas with highest socio-economic advantage have the lowest rates of vaccination.

The present study is the first to examine associations between area-level socio-demographic factors and uptake of vaccination among 5-year old children throughout Australia. A public-health focused ecological methodology was used that combined postcode-level socio-demographic variables from the 2016 Census with postcode-level vaccination data. Analyses included one-way analysis of variance and assessment of linear trends for each socio-demographic variable across five categories of vaccination rate; ranging from lowest (≤90%) to highest (96.1-100%), as well as using vaccination rate as a continuous variable. Multiple regression analysis was also conducted using select indicators to predict vaccination rates in postcodes from major cities. The results of the univariate analyses showed that communities with lower rates of vaccination had relatively less disadvantage, and had relatively greater education and occupation status, as measured by SEIFA (ABS [4]). When we looked at the ASGS Remoteness Areas, we saw that the vaccination rates were lowest in postcodes from the major cities of Australia, and vaccination rates increased as communities became more remote. When the community is further refined to postcodes located in the major cities, and to the target group of parents/partners in a family with children aged 4-7, we found that postcodes with lower vaccination rates were characterised as having a relatively greater proportion of people with: a high education level (bachelor degree level or higher); having white-collar jobs as managers; having no religion, having people in the older age category (50-54); and conversely being unemployed.