Incidence of pneumococcal disease in children ≤48 months old in the United States: 1998-2019.

Background: Pneumococcal disease (PD) is a major cause of morbidity and mortality among children, particularly in the youngest age groups. This study aimed to assess the incidence of PD over time by age group in young children with commercial or Medicaid coverage in the US.
Methods: Episodes of invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) were identified in the MarketScan® Commercial and Medicaid claims databases using diagnosis codes among children aged ≤ 48 months with confirmed date of birth (DoB), at any time during the study period (1998-2019). DoB was assigned using diagnosis codes for birth or delivery using the child's or mother's medical claims to ensure accurate age determination. Annual incidence rates (IRs) were calculated as number of disease episodes/100,000 person-years (PY) for IPD and ACP and episodes/1,000 PY for AOM, for children aged 0-6, 7-12, 12-24, and 25-48 months.
Results: Annual IPD IRs declined from 53 to 7 episodes/100,000 PY between 1998 and 2019 in commercially-insured and 58 to 9 episodes/100,000 PY between 2001 and 2019 in Medicaid-insured children. Annual ACP IRs declined from 5,600 to 3,952 episodes/100,000 PY, and from 6,706 to 4,521 episodes/100,000 PY, respectively, over these periods. In both populations, children aged 0-6 months had the highest incidence of IPD and inpatient ACP. Annual AOM IRs declined from 1,177 to 738 episodes/1,000 PY (commercially-insured) and 633 to 624 episodes/1,000 PY (Medicaid-insured), over these periods. IRs were higher in rural vs. urban areas for all disease manifestations.
Conclusions: Incidence rates of IPD, ACP, and AOM decreased in children with commercial insurance and Medicaid coverage from 1998 to 2019. However, burden of disease remained substantial, with higher annual IRs for IPD and ACP for Medicaid-insured vs. commercially-insured children. IPD and inpatient ACP were most common in the youngest children 0-6 months old, followed by the 7-12-month age group.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors reports financial support was provided by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. Salini Mohanty reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: employment and equity or stocks. Eric M. Sarpong reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: employment and equity or stocks. Meghan White reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: employment and equity or stocks. Jessica Weaver reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: employment and equity or stocks. Thomas Weiss reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: employment and equity or stocks. Nicolae Done reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. Qing Liu reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. Yan Song reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. Travis Wang reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. Katherine Gaburo reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. James Signorovitch reports a relationship with Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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