Predictors of Childhood Vaccination Uptake in England: An Explainable Machine Learning Analysis of Longitudinal Regional Data (2021-2024)

Abstract: Childhood vaccination is a cornerstone of public health, yet disparities in vaccination coverage persist across England. These disparities are shaped by complex interactions among various factors, including geographic, demographic, socioeconomic, and cultural (GDSC) factors. Previous studies mostly rely on cross-sectional data and traditional statistical approaches that assess individual or limited sets of variables in isolation. Such methods may fall short in capturing the dynamic and multivariate nature of vaccine uptake. In this paper, we conducted a longitudinal machine learning analysis of childhood vaccination coverage across 150 districts in England from 2021 to 2024. Using vaccination data from NHS records, we applied hierarchical clustering to group districts by vaccination coverage into low- and high-coverage clusters. A CatBoost classifier was then trained to predict districts' vaccination clusters using their GDSC data. Finally, the SHapley Additive exPlanations (SHAP) method was used to interpret the predictors' importance. The classifier achieved high accuracies of 92.1, 90.6, and 86.3 in predicting districts' vaccination clusters for the years 2021-2022, 2022-2023, and 2023-2024, respectively. SHAP revealed that geographic, cultural, and demographic variables, particularly rurality, English language proficiency, the percentage of foreign-born residents, and ethnic composition, were the most influential predictors of vaccination coverage, whereas socioeconomic variables, such as deprivation and employment, consistently showed lower importance, especially in 2023-2024. Surprisingly, rural districts were significantly more likely to have higher vaccination rates. Additionally, districts with lower vaccination coverage had higher populations whose first language was not English, who were born outside the UK, or who were from ethnic minority groups.