Very young children with comorbidities as well as those who are on Medicaid develop more pneumococcal disease than “healthy” children and those who are covered by commercial insurance (abstract 02c).
The investigators conducted a retrospective, observational cohort study examining two U.S. healthcare claims databases: the Optum Clinformatics Data Mart, which tracks commercial insurance claims, and the Merative MarketScan Multi-State Medicaid Database, which tracks claims to government insurance for low-income families.
The children were younger than 18 years of age and stratified by comorbidities, which included many conditions such as prematurity, asplenia, cancer, and chronic lung, heart, liver and kidney diseases. They evaluated the incidence of invasive pneumococcal disease (IPD), pneumonia, otitis media (OM) and tympanostomy tube insertion between 2015 and 2019.
The highest rates of IPD and pneumonia occurred in infants younger than 24 months of age who had comorbidities compared with those without comorbidities. These rates were evident regardless of their insurance coverage, according to Rotem Lapidot, MD, the interim chief of pediatric infectious diseases at the Rambam Health Care Campus, in Haifa, Israel, and an assistant professor of pediatrics at Boston University School of Medicine. However, the very young children with Medicaid saw higher rates of pneumonia than their peers with commercial insurance.
“One important [finding] is that the children insured by Medicaid had up to 50% more comorbidities,” Dr. Lapidot said. “Another interesting thing to note is that prematurity and asthma … are much more prevalent than other comorbidities in this population.”
Tympanostomy tube insertion was most common in the first 24 months of life, and children with comorbidities underwent more tympanostomy tube insertions regardless of insurance type.
“We can see that the disparities differ between the different clinical syndromes, and each syndrome may have their unique high-risk population,” she said. “Our findings aid in identifying where we should focus the future preventive strategies.”
A limitation of the study was its reliance on claims data, she said. Nevertheless, the findings dovetail with clinical practice, Dr. Lapidot stressed.
“As a clinician, we sometimes don’t recognize how much of a burden for children with asthma pneumococcal disease is,” she explained. “We saw that in the PCV [pneumococcal conjugate vaccine] era, children with comorbid conditions continued to have higher rates of IPD and pneumonia throughout childhood.”
—Landon Gray and Marie Rosenthal, MS, contributed to this column.
The study was funded by Pfizer. Dr. Lapidot reported financial relationships with Merck and Pfizer.
This article is from the June 2023 print issue.