Risk of Pneumococcal Disease in US Adults by Age and Risk Profile

BACKGROUND: Older age and certain medical conditions are known to modify the risk of pneumococcal disease among adults. We quantified the risk of pneumococcal disease among adults with and without medical conditions in the United States between 2016 and 2019. METHODS: This retrospective cohort study used administrative health claims data from Optum's de-identified Clinformatics Data Mart Database. Incidence rates of pneumococcal disease—all-cause pneumonia, invasive pneumococcal disease (IPD), and pneumococcal pneumonia—were estimated by age group, risk profile (healthy, chronic, other, and immunocompromising medical condition), and individual medical condition. Rate ratios and 95% CIs were calculated comparing adults with risk conditions with age-stratified healthy counterparts. RESULTS: Among adults aged 18–49 years, 50–64 years, and ≥65 years, the rates of all-cause pneumonia per 100 000 patient-years were 953, 2679, and 6930, respectively. For the 3 age groups, the rate ratios of adults with any chronic medical condition vs healthy counterparts were 2.9 (95% CI, 2.8–2.9), 3.3 (95% CI, 3.2–3.3), and 3.2 (95% CI, 3.2–3.2), while the rate ratios of adults with any immunocompromising condition vs healthy counterparts were 4.2 (95% CI, 4.1–4.3), 5.8 (95% CI, 5.7–5.9), and 5.3 (95% CI, 5.3–5.4). Similar trends were observed for IPD and pneumococcal pneumonia. Persons with other medical conditions, such as obesity, obstructive sleep apnea, and neurologic disorders, were associated with increased risk of pneumococcal disease. CONCLUSIONS: The risk of pneumococcal disease was high among older adults and adults with certain risk conditions, particularly immunocompromising conditions.