Disparities in Invasive Pneumococcal Disease, Pneumonia, and Otitis Media among US Children by Comorbidity Profile and Insurance Status

Rotem Lapidot^1,2,3,4*Ahuva Averin⁵Derek Weycker⁵Liping Huang⁶Jeffrey Vietri⁶Adriano Arguedas⁶Alejandro Cane⁶Alexander Lonshteyn⁵Mark H. Rozenbaum⁷Stephen I Pelton^1,4

• ¹Boston Medical Center, Boston, Massachusetts, United States
• ²Division of Pediatric Infectious Diseases, Rambam Health Care Campus, Haifa, Haifa, Israel
• ³Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Haifa, Israel
• ⁴Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
• ⁵Avalere Health, Boston, United States
• ⁶Pfizer Inc., Collegeville, PA, United States
• ⁷Pfizer Inc., Capelle a/d IJssel, Netherlands

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 two years of life but became apparent with increasing age.Conclusions: 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.