Applications of geographic information systems in public health: A geospatial approach to analyzing MMR immunization uptake in Alberta.

OBJECTIVE: This study evaluates the temporal, spatial, and spatio-temporal variation of immunization rates for measles, mumps and rubella (MMR) immunization in the province of Alberta. The study uses yearly immunization rate data for Health Zones and Local Geographic Areas (2004-2012), which were obtained from Alberta Health\'s Interactive Health Data Application (IHDA). METHODS: Spatial analyses include a global spatial analysis, Moran\'s I, and local indicators of spatial association (LISA) analysis - Getis and Ord\'s G* - to identify clusters of high or low immunization rates. Spatial methods are then applied to a time series analysis to examine how the immunization rates change over time in conjunction with space. RESULTS: Mapped results indicate decreasing immunization rates over time for the majority of the province where most local geographic areas (LGAs) fall short of the 95% herd immunity threshold. Clusters of high immunization rates in the metropolitan centres, and clusters of low immunization rates in the southern and northern region of the province exist spatially and spatio-temporally. Over time, the high rate clusters are decreasing in size and the low rate clusters are increasing. CONCLUSION: This research provides a localized geographic approach to assessing MMR immunization rates in Alberta. Findings from this research can be used to target public health interventions to specific areas that exhibit the lowest immunization rates. These results can also be used for hypothesis generation in future research on barriers to immunization uptake.