The Impact of Population Health on Childhood Immunizations and Other Health Center Clinical Quality Measures


It is clear that place is a strong determinant of health.1 However, it is not clear how to measure the impact of place on health nor the specific community characteristics that contribute to poor health outcomes. Recent advances in geographic information systems (GIS), including the creation of service area maps, are working toward a better understanding of this impact. Additionally, indices of social deprivation allow us to capture the diverse characteristics that make up communities.2,3

We recently published an article in Family Medicine and Community Health that focuses on incorporating service area-level social deprivation into the analysis of clinical quality performance for the Health Resources and Services Administration’s (HRSA) Health Center Program-supported health centers.4 Service area social deprivation scores were calculated using patient origin data at the ZIP Code level, and weighted based on the number of patients who live in a specific ZIP Code and go to a particular health center. Social deprivation is measured by the social deprivation index (SDI), a composite measure made up of several variables from the American Community Survey (ACS), including poverty, education, housing, and transportation.5

We found that health centers with higher levels of service area-level social deprivation had poorer clinical quality outcomes (blood pressure control, hemoglobin A1c control), even after adjusting for patient and organizational characteristics. However, different patterns in clinical quality process measures emerge for health centers with high levels of service area social deprivation. For example, child immunization rates (children who receive appropriate vaccines by age two) are better for health centers in areas of high social deprivation.

This is of particular interest this week, National Infant Immunization Week (NIIW) 2022. According to the CDC, National Infant Immunization Week is “a time to showcase the achievements of immunization programs and their partners in promoting healthy communities.”6 Despite being nested within some of our nation’s most vulnerable communities, health centers are still getting kids vaccinated. Vaccinations play a vital role in promoting healthy communities, as the CDC estimates that since 1994 alone, vaccines have prevented 419 million illnesses, 27 million hospitalizations, and 936,000 deaths.7 So, as we celebrate NIIW, let’s thank health centers and others who are making vaccinations possible for children in all of our nation’s communities.

To conclude, the findings from this research indicate that community characteristics indeed play a role in health center clinical quality performance, though the impact varies by measure. This research also highlights the need for improved population health strategies involving non-medical services such as language translation, transportation, and housing assistance, such as those provided by health center enabling services.

For more information, read Exploring the Association of Social Determinants of Health and Clinical Quality Measures and Performance in HRSA-Funded Health Centers in Family Medicine and Community Health ( Interested in mapping population health in your own community? Visit today and try our mapping tools.

1. VCU Center on Society and Health. Mapping Life Expectancy. Available from Published September 26, 2016. Accessed July 27, 2021.
2. Bazemore A, Phillips RL, Miyoshi T. Harnessing Geographic Information Systems (GIS) to enable community-oriented primary care. Journal of the American Board of Family Medicine. 2010;23(1):22-31. doi: 10.3122/jabfm.2010.01.090097.
3. Butler DC, Petterson S, Phillips RL, Bazemore AW. Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery. Health Services Research. 2013;48(2 Pt 1):539-559. doi: 10.1111/j.1475-6773.2012.01449.x.
4. Topmiller M, McCann J, Rankin J, et al. Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres. Family Medicine and Community Health. 2021;9(3): e000853. doi:10.1136/fmch-2020-000853.
5. Robert Graham Center. Social Deprivation Index (SDI). Available from Accessed July 27, 2021.
6. National Center for Immunization and Respiratory Diseases. National Infant Immunization Week Overview. Available from Reviewed March 17, 2022. Accessed April 20, 2022.
7. National Center for Immunization and Respiratory Diseases. National Infant Immunization Week. Available from Reviewed March 16, 2021. Accessed April 20, 2022.

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