University of Pittsburgh School of Medicine, Pittsburgh PA, USA.
Vanderbilt University School of Medicine, Nashville TN, USA.
J Natl Med Assoc. 2019 Oct;111(5):540-545. doi: 10.1016/j.jnma.2019.04.011. Epub 2019 Jun 3.
Racial disparities in U.S. adult pneumococcal vaccination rates persist despite reduced barriers to access. Consequently, racial and ethnic minorities experience pneumococcal disease at higher rates than whites. This study examined prevalence of high-risk conditions and pneumococcal hospitalizations among U.S. black and non-black populations aged ≥50 years.
National Health Interview Survey, National Center for Health Statistics and National Inpatient Sample data were used to create black and non-black population cohorts, determine risk factors for pneumococcal disease (pneumococcal vaccine indications) and assess the impact of pneumococcal hospitalization. Each racial cohort was segmented into groups based on the presence of immunocompromising or other pneumococcal high-risk conditions. Persons without those conditions were separated into smokers (also a pneumococcal vaccine indication) and nonsmokers. Mortality was estimated from NCHS life table data. NIS data provided length of stay and costs (calculated from cost to charge ratios) for admissions related to pneumococcal disease including bacteremia, meningitis and nonbacteremic pneumonia.
There were similar proportions of immunocompromised (<5%) and smokers (14%) in both racial cohorts. Likelihood of non-immunocompromising pneumococcal high-risk conditions was higher for blacks than non-blacks at age 65, but higher for non-blacks than blacks at age 80 years (P < 0.001). Age-specific relative likelihood of mortality was 1.1%-12% higher in blacks than non-blacks (P < 0.001). Length of stay was significantly longer for blacks than non-blacks in all age and discharge status groups for non-bacteremic pneumonia and for blacks discharged alive with invasive pneumococcal disease. Costs were higher for blacks 65 years or older with invasive pneumococcal disease.
Marked differences exist between U.S. black and non-black populations in likelihood of conditions conferring a high-risk of pneumococcal disease, and for length of stay and costs of pneumococcal disease hospitalizations. Further research is recommended to identify cost-effective policies or interventions to increase vaccine uptake in higher risk populations.
尽管获得疫苗的障碍有所减少，但美国成年人中肺炎球菌疫苗接种率的种族差异仍然存在。因此，少数族裔比白人更容易患上肺炎球菌病。本研究调查了美国 50 岁及以上的黑人和非黑人人群中高危疾病和肺炎球菌住院的流行情况。
利用全国健康访谈调查、国家卫生统计中心和全国住院患者样本数据，创建黑人和非黑人人群队列，确定肺炎球菌疾病的危险因素（肺炎球菌疫苗接种指征），并评估肺炎球菌住院的影响。每个种族队列根据免疫功能低下或其他肺炎球菌高危疾病的存在情况分为几组。没有这些疾病的人分为吸烟者（也是肺炎球菌疫苗接种指征）和不吸烟者。死亡率是根据 NCHS 生命表数据估计的。NIS 数据提供了与肺炎球菌疾病（包括菌血症、脑膜炎和非菌血症性肺炎）相关的住院治疗的住院时间和费用（根据成本与收费比计算）。
两个种族队列中免疫功能低下者（<5%）和吸烟者（14%）的比例相似。在 65 岁时，非免疫功能低下的肺炎球菌高危疾病的可能性黑人比非黑人高，但在 80 岁时，非黑人比黑人高（P<0.001）。在特定年龄，黑人的死亡率比非黑人高 1.1%-12%（P<0.001）。对于非菌血症性肺炎和黑人患有侵袭性肺炎球菌病且存活出院的所有年龄和出院状态组，黑人的住院时间明显长于非黑人。对于 65 岁或以上患有侵袭性肺炎球菌病的黑人，成本更高。
在美国黑人与非黑人人群中，存在着明显的差异，即发生肺炎球菌疾病高危疾病的可能性不同，以及肺炎球菌疾病住院治疗的住院时间和费用不同。建议进一步研究，以确定增加高危人群疫苗接种的具有成本效益的政策或干预措施。
