Differences in meningococcal disease incidence by health insurance type and among persons experiencing homelessness-United States, 2016-2019

Abstract

Meningococcal disease is a serious but rare disease in the United States. Prior publications suggest incidence differs among privately vs publicly-insured persons, and that incidence is higher among persons experiencing homelessness (PEH) than persons not known to be experiencing homelessness (non-PEH). Using insurance claims data for persons aged <1 to 64 years, we calculated meningococcal disease incidence among a population with employer-sponsored commercial insurance and persons enrolled in state Medicaid programs nationwide. We also examined meningococcal disease incidence by PEH status in Medicaid data. From 2016 through 2019, persons who met our study inclusion criteria contributed a total of 84,460,548 person-years (PYs) to our analysis of commercial insurance data and 253,496,622 PYs to our analysis of Medicaid data. Incidence was higher among persons enrolled in Medicaid (0.12 cases per 100,000 PYs) than persons with commercial insurance (0.06 cases per 100,000 PYs). Incidence was 3.17 cases per 100,000 PYs among PEH in Medicaid, 27 times higher than among non-PEH in Medicaid. Understanding the underlying drivers of the higher meningococcal disease incidence among PEH and persons enrolled in Medicaid may inform prevention strategies for populations experiencing a higher burden of disease.

Fig 1. Study selection process for both United States Centers for Medicare and Medicaid Services, Medicaid data, and MarketScan commercial insurance claims data, 2019.

Fig 2. Meningococcal disease incidence per 100,000 person-years among persons in Centers for Medicare and Medicaid Services, Medicaid data and MarketScan commercial insurance claims data, and per 100,000 persons in National Notifiable Diseases Surveillance Systems data, by age group, 2016–2019.