Health disparities in the burden of pneumococcal disease in US adults

There are significant racial and environmental disparities in the burden of pneumococcal disease. Understanding the role of social determinants of health (SDoH) on pneumococcal disease can help health authorities identify health inequities and develop interventions to reduce these disparities. This targeted literature review (TLR) aimed to examine the clinical and economic burden of pneumococcal disease in US adults with a focus on SDoH such as race, urbanicity, and socioeconomic status. A TLR of studies published between January 2012 and July 2024 was conducted using PubMed (via Medline) and Centers for Disease Control and Prevention (CDC) surveillance data. Supplementary searches were made on Google Scholar to address data gaps. Outcomes of interest were incidence, prevalence, mortality, healthcare resource use, costs, and vaccine coverage rates by race/ethnicity, urbanicity (population density), and socioeconomic variables (income, education, employment status and home ownership). Of 4,609 identified publications, 12 studies were included. Black adults had the highest incidence and mortality rates and longest hospital stay due to pneumococcal disease across all adult age groups. Additionally, Black (compared to non-Black) adults were more likely to be hospitalized at younger ages (50–64 years). Black adults ≥50 years incurred significantly higher pneumococcal disease hospitalization costs compared to non-Black adults. Lower urbanicity displayed higher mortality rates for adults with pneumonia. Adult patients 18–64 years living in more disadvantaged areas had a higher risk of hospitalization for IPD. Similarly, adults living in higher levels of area-based poverty had increased rates of CAP hospitalizations. Incidence of community-acquired pneumonia (CAP) was higher in early retirees and their adult dependents compared to their employed counterparts and adult dependents. Vaccination rates were lower in Black adults, rural residents, those with lower SES, education or income, blue-collar workers, and those who did not own a home. Disparities in pneumococcal disease burden and vaccination uptake exist among US adults, particularly among Black adults, rural residents and those with lower education and income. There is paucity of studies examining disparities in pneumococcal disease and inequities according to race, urbanicity, and socioeconomic status warranting further investigation of the topic to inform prevention strategies.