Table 1 Summary data extracted from studies of childhood vaccination ordered by year of birth of study children
AuthorYear of birth of study childrenMaternal employment measure (prevalence %) and comparatorHealth indicatorUnadjusted ORAdjusted ORVariables included in adjusted analysisQuality rating†
Year of publicationSample population(95% CI)(95% CI)*
Study designSetting/data source % single mothers(OR>1 indicates poorer health outcome)(OR>1 indicates poorer health outcome)
Butler361986Cohort1970Children (n = 13135) aged 5 yearsBritish Births Survey, UK3.9%Mother employed during the child’s life (54.5%) vs not employed during the child’s lifeNot vaccinated against measles or pertussisMeasles: 1.15 (1.07 to 1.23)††Pertussis: 0.93 (0.81 to 1.07)††Measles: No significant association after indirect standardisationPertussis: No adjusted analysisRegion of the country. Number of household moves.Number of other children.Maternal smoking.Type of neighbourhoodII AAA
Adjaye301981Cross-sectional1973–76Mothers (n = 258) of children aged 27–74 monthsSouth London, UKN/RMother’s working status (categories and prevalence not stated)Not vaccinated against measlesNo significant association (OR not reported)No adjusted analysisN/AI A
Coreil371998Cohort1984¶Mothers (n = 5212) of children aged 5 yearsPublic schools in Florida, USAN/RMother working ⩾21 hours per week [54.3%] vs working <21 hours per weekIncomplete vaccination at time of school entryNo data available0.94 (p>0.67)Mother’s age/education. Household income. Child’s gender/ethnicity. Number of siblings living at homeII AAA
Jones391994Cross-sectional1988–90¶Children (n = 208) aged 2–4 yearsMilitary hospital-based paediatric clinic, USA9%Both parents employed full-time (39.7%) vs not employed full-timeNot optimally vaccinated before second birthday1.78 (0.84 to 3.78)††No adjusted analysisN/AII AA
Wood251995Cross-sectional1989–91¶Children aged 12–36 months, of African American (n = 301) or Latino (n = 724) ethnic originLos Angeles, USAAfrican American = 57%, Latino = 26%Mother working (African American mothers = 30%; Latino mothers = 19%) vs not workinga) Not in receipt of all required vaccines at age 3 monthsb) Not in receipt of all required vaccines at 24 monthsa) African American: association, p<0.1 (OR and direction not reported)Latino: association, p<0.1 (OR and direction not reported)b) Association for both ethnic groups, p<0.1 (OR and direction not reported)a) African American: 0.50 (0.27 to 0.91)††Latino: no significant association (OR not reported)b) No significant association for either ethnic group (OR not reported)a) Both ethnic groups: number of pre-school children in household. Child age/gender/health status. Family income. Mother’s marital status/education. Health insurance. Source of well-child care. Family mobilityAdditional variables included for the African American§ and Latino ethnic groups**b) Both ethnic groups: child age/health status. Mother’s marital status/education. Source of well-child careAdditional variables included for the African American§ and Latino ethnic groups**II AA
Impicciatore382000Cross-sectional1990–96¶Mothers [n = 1035] of children aged 3.6 months-6.4 yearsPublic spaces in three urban/three rural areas, ItalyN/RMother has part-time or full-time job (53%) vs unemployedNot fully vaccinated (or up to date) against MMR or pertussisMMR:0.58 (0.45 to 0.75)††Pertussis:0.78 (0.61 to 1.00)††MMR:No significant association (OR not reported)Pertussis:No significant association (OR not reported)Mother’s residency/educational level/age/attitude towards immunisation. Setting. Family size. Child’s position in family. Year of child immunisation. Information on immunisationII A
Alio272005Cross-sectional1991–2000Children (n = 10525) aged 0–5 years1996–2000 Medical Expenditure Panel Survey public use files, USABlack = 60%, White = 24%Mother employed (Black mothers = 67.1%; White mothers = 63%) vs not employedNot receiving preventive care (including up to date vaccination)No data available0.96 (0.84 to 1.09)Mother’s race/insurance coverage/age/education. Family sizeIII AAA
The following two papers analysed data collected in the same study
Bates321994Cohort1992Mothers (n = 500) of children aged 0–12 monthsLarge municipal teaching hospital, Midwest USA72%Mother employed (24%) vs not employedNot up to date with vaccination at age 3 and 7 monthsAt age 3 months:0.92 (0.58 to 1.44)‡At age 7 months:0.82 (0.52 to 1.30)‡Adjusted analysis does not include maternal employment variableN/AII AAA
Bates331998Cohort1992Mothers (n = 500) of children aged 24–30 monthsLarge municipal teaching hospital, Midwest USA71%Mother’s employment (categories and prevalence not stated)Not up to date with vaccination at age 2 yearsNo significant association (paper presents neither OR nor data required to calculate OR)Adjusted analysis does not include maternal employment variableN/AII AAA
Brenner352001Cohort1994–95¶Mothers (n = 452) of children aged 0–12 monthsThree hospitals in the District of Columbia, USA71%Mother employed postpartum (37%) vs not employed (including students)Not up to date with vaccination at age 3 and 7 monthsAt age 3 months:0.64 (0.37 to 1.11)‡At age 7 months:0.53 (0.34 to 0.85)‡At age 3 months:adjusted analysis does not include maternal employment variableAt age 7 months:0.52 (0.31 to 0.87)‡At age 3 months:N/AAt age 7 months:Child birth order/birthweight. Mother’s drug use. Intended infant sleeping position. Someone in home with a drug problem. WIC during pregnancyII AA
Bond341999Cross-sectional1994–97¶Children (n = 1779) aged 0–35 monthsCouncil-run family day care or centre-based care in Melbourne, Australia13%Mother in paid employment (80%) vs no paid employmentIncomplete or no vaccination0.67 (0.48 to 0.90)Maternal employment variable not listed as significantly associated with vaccination; unclear whether or not it was included in adjusted analysisSee previous columnII AA
Matsumura262005Cross-sectional1998–2000¶Children (n = 5047)Health check-ups at age 18 months or 36 months in Kyoto City, JapanN/RMother working (25% at 18 months; 33.3% at 36 months) vs not workingIncomplete vaccination against measles at age 18 or 36 monthsAt age 18 months:1.66 (1.37 to 2.01)At age 36 months:2.60 (1.95 to 3.49)At age 18 months:1.38 (1.00 to 1.89)At age 36 months:1.75 (1.16 to 2.66)Mother’s age/concern about the adverse effects of measles/knowledge of measles. Not the firstborn child. Child’s interaction with other children. Presence of allergies in childIII AAA
Iordanou312006Cross-sectional<2000¶Children (n = 500) aged 5–6 years at primary school entrySelected areas of Greece4%Mother’s profession (various categories  = 44%) vs mother as ‘housekeeper’Incomplete or no vaccination against diphtheria, tetanus and pertussisDTP and DT vaccines:rates of incomplete or no vaccination higher among employed mothers, p<0.002 (OR not reported)DTP and DT vaccines:1.34‡ (CI not reported)UnclearI A
Samad402006Cohort2000–02Children (n = 18488) aged 9 monthsMillennium Cohort Study, UK17%Mother has returned to or started work since birth of cohort baby (46%) vs not returned to or started work since birth of cohort babyPartially or not vaccinated at age 9 monthsNo data availablePartially vaccinated:rate ratio  = 0.7 (0.6 to 0.8)Not vaccinated:rate ratio  = 0.6 (0.4 to 0.8)Mother’s age at birth of cohort child/education/smoking/ethnic group. Family size. Country of UK. Ward type. Lone parenthood. Infant’s hospital admissionII AAA
Theeten412007Cross-sectional2003Children (n = 1349) aged 18–24 monthsFlanders, BelgiumN/Ra) Mother in full-time salaried employment (33%) vs not workingb) Mother in less than full-time employment or freelance (39%) vs not workingNot in receipt of complete, valid (correctly timed) vaccination scheduleNo data availablea) 0.56 (0.42 to 0.77)‡b) 0.91 (0.67 to 1.25)‡Maternal and paternal age/educational level. Main vaccinator. Province of residence. Family income. Age of the child. Use of day care. Number of siblingsII AAA
  • CI, confidence intervals; DT, diphtheria and tetanus vaccine; DTP, diphtheria, tetanus and pertussis vaccine; MMR, measles, mumps and rubella vaccine; N/A, not applicable; N/R, not recorded; OR, odds ratio; WIC, Special Nutrition Program for Women, Infants and Children.

  • *95% confidence intervals, unless otherwise stated.

  • †III  =  strong internal validity (four or more domains strong or three domains strong and none weak); I =  weak internal validity (three or more domains weak); II  =  moderate internal validity (those not fulfilling criteria for strong or weak). AAA  =  findings likely to be applicable across a broad range of populations and settings (but may need appropriate adaptation); AA  =  findings applicable only to populations and settings included in the study – success of broader application is uncertain; A =  applicable only to populations and settings included in the study.

  • ‡Odds ratio calculated by review authors using data derived from the published paper.

  • ¶Estimated year of birth of study children.

  • §Analyses at 3 months  =  receipt of immunisation information from friends/relatives, given appointment in hospital for first well child visit, and mother’s use of preventive services; analyses at 24 months  =  family mobility and patient satisfaction with care.

  • **Analyses at 3 months  =  ‘shot’ (ie vaccination) information from the media, number of family financial difficulties reported, belief that shots prevent colds/diarrhoea, use of seatbelt, percentage of pre-school children on WIC, receipt of six or more prenatal visits, and sampling area; analyses at 24 months  =  number of pre-school children in household and sampling area.