P-1491. Invasive Meningococcal Disease Incidence and Risk Among Commercially- and Medicaid-Insured Infants in the United States

TL;DR

This study found that invasive meningococcal disease rates are higher in Medicaid-insured infants and those with certain health conditions, especially in the first few months of life.

Contribution

The study provides new insights into the incidence and risk factors of invasive meningococcal disease in U.S. infants based on insurance type and clinical conditions.

Findings

The incidence rate of invasive meningococcal disease was higher in Medicaid-insured infants (1.97) compared to commercially-insured infants (0.45).

Infants aged 0–<4 months had the highest incidence rates in the Medicaid cohort.

Clinical conditions like preterm delivery, renal disease, and complement component deficiency were associated with significantly higher incidence rates.

Abstract

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, is an uncommon but serious disease. The highest incidence rates (IRs) in the United States (US) are reported among infants (< 1 year). In this study, we estimated IMD IRs by patient characteristics (month [m] of age and clinical conditions) among commercially- and Medicaid-insured US infants.

Claims data of commercially- and Medicaid-insured infants from 01/2005–12/2022 were analyzed. Eligibility was based on birth dates (index date: first date patient met the age and enrollment criteria). Conditions known to increase IMD risk (eculizumab use, asplenia, human immunodeficiency virus, complement component deficiency [CCD], sickle cell disease) and those hypothesized to increase IMD risk (asthma, autoimmune disease, type 1 diabetes, corticosteroid use, immunocompromised status, malignancy, preterm delivery, renal disease) were assessed. IRs were estimated per 100,000 person-years (PYs); IR ratios (IRRs) and 95% confidence intervals were calculated to compare infants with each clinical condition to those without the condition.

In the commercial (N=7.2 million) and Medicaid (N=7.4 million) cohorts, 21 and 115 infants were diagnosed with IMD, respectively. The overall IMD IR was higher in the Medicaid cohort (IR=1.97) versus the commercial cohort (IR=0.45). In the Medicaid cohort, the highest IRs were observed for infants aged 0–< 1 m (IR=2.20), 1–< 2 m (IR=4.65), 2–< 3 m (IR=2.72), and 3–< 4 m (IR=3.74). The highest IR in the commercial cohort was observed for infants aged 2–< 3 m (IR=1.03; Table 1). IRRs across both cohorts were >1 among infants with preterm delivery (commercial: n=2, IR=0.83; Medicaid: n=19, IR=3.55), renal disease (commercial: n=2, IR=27.06; Medicaid: n=3, IR=20.53), and CCD (commercial: n=1, IR=303.44; Medicaid: n=1, IR=269.62; Table 2).

Overall, IMD incidence was low. IRs were higher among Medicaid-insured infants, infants aged < 4 m, and infants with certain clinical conditions. Whilst targeted mitigation strategies may reduce IMD burden among high-risk groups, difficulty in identifying individuals at increased risk, especially at an early age, may necessitate a broader approach.

Funding: GSK VEO-000994

Oscar Herrera-Restrepo, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Elizabeth Packnett, MPH, GSK: Grant/Research Support|Merative: Employee Megan Richards, PhD, MPH, GSK: Grant/Research Support|Merative: Employee Elise Kuylen, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Tosin Olaiya, MBChB, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company) Thatiana Pinto, PhD, GSK: employee|GSK: Stocks/Bonds (Public Company) Lindsay Landgrave, PharmD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Andrew G. Allmon, DrPH, GSK: Employee|GSK: Stocks/Bonds (Public Company)

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