Effect of chronic disease rates and diagnoses on young adult pneumococcal vaccination status in the All of Us database

Vaccine disparities in the United States contribute to downstream health inequities. Until late 2024, pneumococcal conjugate vaccine (PCV) and/or pneumococcal polysaccharide vaccine (PPSV) was only recommended for those adults under 65 with certain chronic conditions. Prior studies have shown that, unlike other vaccines, PCV/PPSV uptake is comparable or even higher among non-Hispanic (NH) Black individuals under 65 compared to NH-White individuals. One proposed explanation is a higher burden of chronic disease and multimorbidity in NH-Black populations. We used data from the National Institutes of Health All of Us database to examine this pattern. Eligible participants ( N = 87,005) were ≥ 18 years old, completed the Personal and Family Health survey, consented to electronic health record (EHR) access, and had ≥1 chronic disease indication for PCV/PPSV between ages 18–64. Vaccination was defined as ≥1 EHR-recorded PCV/PPSV dose between ages 18–64. Overall, 14,495 participants (17 %) had received PCV/PPSV. The cohort was majority female (59.8 %), NH-White (64.3 %), with a mean age of 54.5 years; most had private insurance (50.8 %). Vaccination prevalence was highest among NH-Black participants (18.8 %), followed by NH-White (17.1 %), Other (15.6 %), Hispanic (13.2 %), and Asian (12.5 %).Multivariate regression adjusting for sociodemographic and chronic disease burden found higher odds of vaccination among NH-Black individuals (AOR = 1.10, 95 % CI: 1.03–1.17) and lower odds among Hispanic individuals (AOR = 0.75, 95 % CI: 0.69–0.82, p < 0.001) compared to NH-White participants. Greater chronic disease burden partially explained but did not fully account for these disparities. These findings demonstrate the importance of further research to evaluate humanistic and/or health systems factors that contribute to the racial/ethnic trends in pneumococcal vaccination in younger adults, as variations in sociodemographics, rates of comorbidities, and rates of multimorbidity do not fully explain the observed pattern. • Vaccination was highest in Black young adults, lower in other minority groups. More and certain chronic comorbidities increased odds of pneumococcal vaccination. • Specific diagnoses and multimorbidity did not explain racial/ethnic disparities. • Perceptions and system factors may explain disparities beyond clinical indicators. • Next steps will evaluate additional factors that may explain disparities. • Data are from the NIH All of Us database, a large U.S. health dataset.