Table 1_Disparities in invasive pneumococcal disease, pneumonia, and otitis media among US children by comorbidity profile and insurance status.xlsx

BackgroundNear-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.
MethodsWe 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.
ResultsChildren 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.
ConclusionChildren 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.

背景：美国儿童群体近乎全面普及的肺炎球菌结合疫苗（pneumococcal conjugate vaccines）接种，已使儿童侵袭性肺炎球菌疾病（invasive pneumococcal disease, IPD）、肺炎（pneumonia, PNE）及中耳炎（otitis media, OM）的发病例数大幅减少，尤其在高危人群中。本研究旨在评估13价肺炎球菌结合疫苗（PCV13）推广应用后，美国儿童按合并症特征与保险类型（作为社会经济地位的替代指标）划分的疾病负担残留差异。
方法：本研究采用两项美国医疗索赔数据库开展回顾性观察队列研究，分别为Optum Clinformatics DataMart（商业保险人群数据库）与Merative MarketScan医疗补助保险（Medicaid）多州数据库。两项研究的队列均纳入年龄<18岁的儿童，并按年龄与合并症特征进行分层。研究结局指标包括IPD、PNE、OM及鼓膜置管术（tympanostomy tube, TT）植入，随访期间每月对结局事件进行确认。疾病发病率以每10万人年为单位表示，并按保险类型与合并症特征计算年龄特异性相对发病率。
结果：无论保险类型如何，年龄<2岁的合并症患儿的IPD与PNE发病率均为最高。拥有医疗补助保险（Medicaid）的儿童，其IPD与PNE发病率也高于商业保险儿童；此类差异通常随年龄增长而逐渐缩小。合并症患儿与非合并症患儿的OM及TT植入发生率差异在出生后前2年并不显著，但随年龄增长逐渐显现。
结论：合并症患儿与拥有医疗补助保险（Medicaid）的儿童，其IPD、PNE及OM的疾病负担更高。研究人员应评估预防策略对高发病风险儿科人群的影响，以明确健康公平目标的实现进展。