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

## TL;DR

This study finds that young children with health issues or Medicaid insurance still face higher rates of pneumococcal diseases despite widespread vaccine use.

## Contribution

The study identifies residual disparities in pneumococcal disease burden among children with comorbidities and Medicaid insurance in the post-PCV13 era.

## Key findings

- Children with comorbidities under 2 years old had the highest rates of IPD and PNE regardless of insurance.
- Medicaid-insured children had higher IPD and PNE rates than commercially insured children, with gaps narrowing as children age.
- Differences in OM and TT insertion rates emerged with age in children with comorbidities.

## Abstract

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.

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.

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.

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.