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. 2025 May:241:108050.
doi: 10.1016/j.rmed.2025.108050. Epub 2025 Mar 22.

Early-life pneumonia and subsequent risk of respiratory disease among commercial-insured and medicaid-insured children with and without high-risk conditions

Ahuva Averin  1 , Stephen I Pelton  2 , Derek Weycker  3 , Liping Huang  4 , Jeffrey Vietri  4 , Maria J Tort  4 , Adriano Gerardo Arguedas Mohs  4 , Alejandro Cane  4 , Mark H Rozenbaum  5 , Rotem Lapidot  6
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Free article

Early-life pneumonia and subsequent risk of respiratory disease among commercial-insured and medicaid-insured children with and without high-risk conditions

Ahuva Averin et al. Respir Med. 2025 May.
Free article

Abstract

Background: Evidence suggests that early-life community-acquired pneumonia (CAP) among healthy children increases their risk of subsequent chronic respiratory disorders. This study extends prior research by including children with and without comorbidities and conducting analyses using two databases.

Methods: Data were obtained from the Optum Electronic Health Record Database (commercial subset) and Merative Medicaid Multi-State Database. Study populations comprised children hospitalized for CAP before age 2 years ("CAP patients") as well as matched "comparison patients." Rates of study outcomes-including chronic respiratory disease (CRD), reactive airway disease (RAD), CAP hospitalization-from age 2-5 years were calculated for CAP/comparison patients in each study population, overall and by comorbidity profile.

Findings: Rates of study outcomes from age 2-5 years were markedly higher among CAP (vs. comparison) patients in commercial-insured and Medicaid-insured populations, by: 1·9 and 1·5 for CRD; 2·5 and 2·0 for RAD; 6·4 and 7·3 for CAP hospitalization. CAP patients with (vs. without) comorbidities had numerically higher rates of outcomes, but relative rates of outcomes for CAP (vs. comparison) patients were largely comparable irrespective of comorbidity profile.

Interpretation: CAP before age 2 years is associated with increased rates of CRD from age 2-5 years and the proportion of children with subsequent CRD is highest among those with comorbidities. These observations suggest a potential causative role for early-life CAP in subsequent CRD.

Keywords: Child; Infant; Pneumonia; Respiratory tract diseases.

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Conflict of interest statement

Declaration of competing interest The study was sponsored by Pfizer Inc. Ahuva Averin and Derek Weycker are employees of Avalere Health, which received funding from Pfizer Inc. in connection with the development of this manuscript and study. Stephen I. Pelton is employed by Boston University Schools of Medicine and Public Health and Boston Medical Center, and Rotem Lapidot is employed by Boston University Schools of Medicine and Public Health, Boston Medical Center, and Rambam Health Care Campus; Drs. Pelton and Lapidot received financial support from Pfizer Inc. for participation in study design, data analysis, and data interpretation. Liping Huang, Jeffrey Vietri, Maria J. Tort, Adriano Gerardo Arguedas Mohs, Alejandro Cane, and Mark Rozenbaum are employed by Pfizer Inc. and hold Pfizer stock.

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