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Publications

Journal Article Observational Study Epublish

PubMed: 40756406 DOI: 10.3389/fpubh.2025.1558157

Disparities in invasive pneumococcal disease, pneumonia, and otitis media among US children by comorbidity profile and insurance status.

Front Public Health 13:1558157

Authors: Rotem Lapidot, Ahuva Averin, Derek Weycker, Liping Huang, Jeffrey Vietri, Adriano Arguedas, Alejandro Cane, Alexander Lonshteyn, Mark H Rozenbaum, Stephen I Pelton

Affiliations

  • Boston Medical Center, Boston, MA, United States.
  • Division of Pediatric Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
  • Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
  • Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
  • Avalere Health, Washington, DC, United States.
  • Pfizer Inc. Collegeville, PA, United States.
  • Pfizer Inc. Capelle a/d IJssel, Netherlands.

Abstract

Background

Near-universal pediatric use of pneumococcal conjugate vaccines in the United States (US) has yielded substantive reductions childhood invasive pneumococcal disease (IPD), pneumonia (PNE), and otitis media (OM), especially among at-risk populations. We evaluated residual disparities in disease burden among US children by comorbidity profile and insurance type (as a proxy for socioeconomic status) during the post-PCV13 era.

Methods

We conducted a retrospective observational cohort study using two US healthcare claims databases: Optum Clinformatics DataMart (commercial) and Merative MarketScan Medicaid Multi-State Database. The two study populations comprised children aged <18 years and were stratified by age and comorbidity profile. Study outcomes included IPD, PNE, OM, and tympanostomy tube (TT) insertion, and were ascertained monthly during the follow-up period. Disease rates were expressed per 100,000 person-years, and age-specific relative rates were calculated by insurance type and comorbidity profile.

Results

Children with comorbidities aged <2 years had the highest rates of IPD and PNE, regardless of insurance status. Rates of IPD and PNE were also higher in children with Medicaid (vs. commercial) insurance; differences generally decreased with increasing age. Differences in incidence of OM and TT insertions between children with (vs. without) comorbidities were absent in the first 2 years of life but became apparent with increasing age.

Conclusion

Children with comorbidities and those with Medicaid insurance have a higher burden of IPD, PNE, and OM. Researchers should assess the impact that preventative strategies have on pediatric populations with the highest rates of disease to identify progress in achieving equity in health.

MeSH

Comorbidity, Pneumococcal Infections, Insurance Coverage, Insurance, Public Health, Aged, Pneumonia, Otitis Media, Otitis, Infections, Child