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All regressions allowed a flexible, non-linear relationship between coverage and mortality.
Since the relationship between coverage and mortality is not necessarily linear, coverage was either categorized using indicator variables or entered as restricted cubic splines [25].
It captures nonlinearities in the relationship between coverage and mortality, relevant for considering potential health benefits due to increased coverage for countries starting at different MCV coverage levels.
While we do not directly observe information on interruption in chains of infection transmission at different coverage levels, we interpret the non-linearities in the relationship between coverage and mortality as an indication of herd immunity.
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It characterizes the historical relationship between MCV coverage and mortality as observed across 44 countries over the past 40 years.
The restricted cubic spline model specification was compared to: 1) a model without MCV coverage; and 2) a model with a constant log-linear relationship between MCV coverage and mortality.
Because epidemiological targets are expressed in terms of mortality reductions, and because accurate measles incidence data are difficult to obtain for many countries, we chose to model a reduced-form relationship between MCV coverage and mortality.
A potential explanation for the lack of relationship between coverage and cervical cancer mortality lies on how the Colombian Health system is structured.
Such an assessment emphasises that 'effective' coverage needs a balance between coverage and quality of implementation.
Other covariates were included in the models because of their direct or indirect relationships with measles mortality or their potential to modify the relationship between MCV coverage and measles mortality.
Kronick determined that when underlying health factors of the population were considered, no connection could be proven between health coverage and lower mortality.
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