Parental education disparities in childhood vaccination in Denmark: A test of two explanations for the role of misinformation.

How does misinformation contribute to socioeconomic disparities in childhood vaccine uptake? While prior research has extensively examined the determinants of vaccination at the population-level, less attention has been paid to the mechanisms generating disparities across socioeconomic status (SES) groups. A fundamental cause theory perspective suggests that vaccination disparities driven by misinformation are due to unequal access to resources that enable higher-SES parents to avoid the influence of such misinformation. By contrast, a neoliberal cultural frames of parenting perspective suggests that higher-SES parents, in trying to avoid risks for their child, would be more receptive to inaccurate claims that arise outside the mainstream medical and scientific community. We test hypotheses from these two perspectives using 22 birth cohorts of Danish national health registry data (1990-2011) analyzing uptake of children's first dose of the measles, mumps, and rubella vaccine (MMR1) by parental education level in the context of three major vaccine misinformation events: two promoting and one correcting misinformation. We find that educational disparities in MMR1 uptake emerged following a 1993 national radio broadcast that falsely linked the vaccine to autism and helped catalyze anti-vaccine activism in Denmark. Children of parents with the lowest education were most severely impacted, and these disparities persisted through the 1998 publication and 2010 retraction of Andrew Wakefield's widely publicized MMR vaccine and autism study. Together, these findings generally support fundamental cause theory-based explanations and demonstrate persisting and unequal harms of misinformation on child and community health.