OBJECTIVES: Parental vaccine hesitancy is a major obstacle to childhood vaccination. We assessed the subjective socioeconomic status (SES) of parents and examined its impact on parental vaccine hesitancy.

METHODS: A questionnaire survey was performed on parents with children aged below 6 years from six provinces in China. Subjective SES was measured by perceived social status relative to others on a scale of 1-10. Vaccine hesitancy was assessed using a previously developed vaccine hesitancy scale in China. Linear regression was applied to assess the association between subjective SES and vaccine hesitancy. Robustness and heterogeneity analyses were conducted to further validate their relationship.

RESULTS: A total of 1,638 parents were included. The average subjective SES score was 5.82 (SD=1.45). Subjective SES had a U-shaped effect on vaccine hesitancy, with a turning point at 6.09. Robustness analysis supported the U-shaped relationship between the two. Parental confidence and complacency level (two sub dimensions of vaccine hesitancy) contributed to explaining the U-shaped relationship. Confidence was positively associated with subjective SES, while complacency had a U-shaped relationship with subjective SES. Heterogeneity analyses showed that the U-shaped relationship among parents with low household income was flatter. Subjective SES still had a U-shaped impact on vaccine hesitancy among parents who do not work in healthcare settings, but showed a positive linear impact on vaccine hesitancy among parents working in healthcare settings.

CONCLUSIONS: There was a U-shaped relationship between parents' subjective socioeconomic status and vaccine hesitancy, which was partly formed by parental vaccine confidence and complacency level.