The effect of geographical variation in income measures on Measles-Mumps-Rubella uptake and coverage in England; a protocol for an ecological study

3. ABSTRACT Measles is a vaccine-preventable disease whose vaccine was introduced in the United Kingdom in 1988, however, Measles outbreaks are still occurring in England. Consequently, the World Health Organization (WHO) removed the UK’s elimination status of Measles in 2019. Noticeably, MMR vaccination coverage in England is below the recommended threshold with geographical variations across local authorities (LA). The research into the effect of income disparities on MMR vaccine coverage was insufficiently examined. Therefore, an ecological study will be conducted aiming at determining whether there is a relationship between income deprivation measures and MMR vaccine coverage in upper-tier local authorities in England, using 2019 publicly available data. The effect of spatial clustering of income level on vaccination coverage will also be assessed. Vaccination coverage data will be obtained from “Cover of Vaccination Evaluated Rapidly (COVER)”. Income deprivation score, Deprivation gap, and Income Deprivation Affecting Children Index will be obtained from Office for National Statistics and Moran’s Index will be generated using RStudio. Rural/urban LA classification and mothers’ education will be included as possible confounding factors. Additionally, the live births rate per mothers’ age group will be included as a proxy for the mothers’ age variation in different LA. Multiple linear regression will be used after testing the relevant assumptions, using SPSS software. Moran’s I together with income deprivation score will be analysed through regression and mediation analysis. This study will help in determining whether income level is a determinant of MMR vaccination uptake and coverage in LA in England which would help policymakers in designing targeted campaigns, thus preventing measles outbreaks in the future.