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Regression analyses were used to quantify the change in inequalities in vaccine uptake over time\u2014expressed as changes in the slope index of inequality (SII). Cumulative susceptibility to measles and rotavirus disease at age 5 years was estimated. Analyses were repeated at regional level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The absolute inequality in vaccine uptake at baseline (2019-20) was largest for MMR2 in children at age 5 years (SII \u22129.6%, 95% confidence interval (CI) \u221210.2% to \u22129.0%). For all vaccinations studied, the SII for uptake increased over the study period: from \u22125.1% to \u22127.7% for the six-in-one vaccine, \u22127.4% to \u221210.2% for rotavirus, \u22127.9% to \u22129.7% for PCV booster, \u22128.0% to \u221210.0% for MMR1 at age 2 years, \u22123.1% to \u22125.6% for MMR1 at age 5 years, and \u22129.6% to \u221213.4% for MMR2 at age 5 years. The number of children susceptible to measles by the end of the study period increased 15-fold in the least deprived group (from 1364 to 20\u2009958) and 20-fold in the most deprived group (from 1296 to 25\u2009345). For rotavirus, a 14-fold increase was observed in the least deprived group (from 2292 to 32\u2009981) and a 16-fold increase in the most deprived group (from 2815 to 45\u2009201). Regional analysis showed greatest inequalities in uptake in London and the northern regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings of this study suggest that inequalities in childhood vaccination are increasing in England, as uptake rates for five key childhood vaccinations decreased between 2019 and 2023, below the World Health Organization\u2019s recommended 95% uptake target, and with noticeable regional differences. Urgent action is needed to strengthen systems for childhood vaccination, with a key focus on reducing inequalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2024-079550","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T23:56:53Z","timestamp":1733961413000},"page":"e079550","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Inequalities in uptake of childhood vaccination in England, 2019-23: longitudinal study"],"prefix":"10.1136","volume":"387","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0023-0976","authenticated-orcid":false,"given":"Aidan","family":"Flatt","sequence":"first","affiliation":[{"name":"National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK"},{"name":"Health Protection Operations, United Kingdom Health Security Agency (UKHSA), Liverpool, 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Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK"},{"name":"Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Quinn","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK"},{"name":"Public Health, Tameside Local Authority, Ashton-under-Lyne, Tameside, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1959-5094","authenticated-orcid":false,"given":"Matthew","family":"Ashton","sequence":"additional","affiliation":[{"name":"Public Health, Liverpool Local Authority, Liverpool, 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