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Observational Study
. 2025 Jul 18:13:1558157.
doi: 10.3389/fpubh.2025.1558157. eCollection 2025.

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

Rotem Lapidot  1   2   3   4 , Ahuva Averin  5 , Derek Weycker  5 , Liping Huang  6 , Jeffrey Vietri  6 , Adriano Arguedas  6 , Alejandro Cane  6 , Alexander Lonshteyn  5 , Mark H Rozenbaum  7 , Stephen I Pelton  1   4
Affiliations
Observational Study

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

Rotem Lapidot et al. Front Public Health. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Streptococcus pneumoniae; child; infections; otitis media; pneumonia.

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Conflict of interest statement

AC, LH, AdA, MR, and JV are employed by, and own stock in, Pfizer Inc. SP and RL received financial support from Pfizer Inc. for participation in study design, data analysis, and data interpretation. AhA, AL, and DW are employees of Avalere Health, which received funding from Pfizer in connection with this study and the development of this manuscript. This study was sponsored by Pfizer. The funder was involved with study concept, analysis; critical review of the manuscript; and the decision to submit the manuscript for publication. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Rates (per 100 K PY) of (A) IPD, (B) Pneumonia, (C) Otitis Media, and (D) Tympanostomy Tube Insertion in commercial and Medicaid study populations, by age and comorbidity profile. CC+, children with comorbid conditions; CC-, children without comorbid conditions; PY, person-years.
See this image and copyright information in PMC

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