{
  "abstract": "Introduction\n\nChildhood vaccination coverage in the United States has declined in recent years, raising concern about the reemergence of vaccine-preventable diseases. We examined whether state-level political partisanship was associated with routine childhood vaccination coverage after adjustment for socioeconomic factors from 2014 to 2024.Methods\n\nWe conducted a cross-sectional ecological study using publicly available state-level panel data from 50 states and the District of Columbia from 2014 to 2024. The analytic panel included 561 state-year observations. The primary outcome was measles-mumps-rubella coverage; secondary outcomes were diphtheria-tetanus-acellular pertussis, poliovirus, and hepatitis B coverage. Multivariable ordinary least squares regression with year fixed effects, Welch t tests, analysis of variance, and interaction models were used. Data were analyzed in March 2026. Sensitivity analyses included two-way (state and year) fixed-effects specifications, persistence-classification subset models (states with consistent presidential vote outcomes across multiple elections), and county-level analyses.Results\n\nBlue states had higher mean measles-mumps-rubella (MMR) vaccination coverage than red states (89.69% vs. 87.34%), a difference of 2.35% points (P<.001). In adjusted analyses with racial composition included as a covariate, higher Republican presidential vote share was associated with lower MMR vaccination coverage (b=-10.90; 95% CI=-16.69, -5.10; P<.001; n = 406 state-year observations). Every 10-percentage-point increase in Republican vote share corresponded to approximately 1.09%-point lower MMR vaccination coverage. Political-educational strata differed in coverage (analysis of variance P<.001), and the political association did not strengthen over time (interaction P=.38). Persistence-based sensitivity analyses among states with consistent presidential vote outcomes across four elections (2012-2024) and three elections (2016-2024) yielded strengthened associations (b=-14.30, P<.001, n = 326; and b=-13.17, P<.001, n = 350, respectively). Within-state county-level analyses (county fixed effects and state-stratified specifications) were directionally consistent with the state-level finding (n = 411 county-year observations from a 2023 cross-section across four states).Conclusions\n\nState-level political context was associated with vaccination coverage after socioeconomic adjustment. Immunization surveillance, communication, and outreach strategies may benefit from accounting for undercoverage risk.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA. lin.wei@mayo.edu.",
    "Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Wei Lin",
      "orcid": "0000-0003-2332-924X"
    },
    {
      "affs": [
        1
      ],
      "name": "Seyed M Mirsattari"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/axk338ww01c7f.bib",
  "cited_by": 0,
  "doi": "10.1186/s12889-026-27675-9",
  "fulltext_url": "https://europepmc.org/articles/PMC13679233",
  "id": "axk338ww01c7f",
  "issns": [
    "1471-2458"
  ],
  "landing_url": "https://europepmc.org/article/MED/42897547",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ],
    [
      "openalex",
      "3306|Vaccine Coverage and Hesitancy"
    ]
  ],
  "openalex": "W7170181527",
  "pdf_url": "https://europepmc.org/articles/PMC13679233?pdf=render",
  "pmcid": "PMC13679233",
  "pmid": "42897547",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/axk338ww01c7f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:42Z",
      "native_id": "MED:42897547",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42897547"
    },
    {
      "first_seen": "2026-10-30T13:46:35Z",
      "native_id": "a33ac89a5c0949488e45237287f15272",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s12889-026-27675-9"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RA1-1270",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Political polarization, educational attainment, and childhood vaccination coverage in the United States, 2014-2024: a cross-sectional study.",
  "title_text": "Political polarization, educational attainment, and childhood vaccination coverage in the United States, 2014-2024: a cross-sectional study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:35Z",
  "url": "https://research.draconitic.com/paper/axk338ww01c7f",
  "venue": "BMC public health",
  "versions": []
}