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Socioeconomic inequalities in vaccine uptake: A global umbrella review

Lookup NU author(s): Amber Sacre, Professor Clare Bambra, Dr Josephine Wildman, Dr Katie ThomsonORCiD, Dr Natalie BennettORCiD, Dr Sarah SowdenORCiD, Professor Adam ToddORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.10.1371/journal.pone.0294688

Publication metadata

Author(s): Sacre A, Bambra C, Wildman JM, Thomson K, Bennett N, Sowden S, Todd A

Publication type: Article

Publication status: Published

Journal: PLoS ONE

Year: 2023

Volume: 18

Online publication date: 13/12/2023

Acceptance date: 06/11/2023

Date deposited: 14/12/2023

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0294688


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Funder referenceFunder name
National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)