Data Science Center, Jichi Medical University, Shimotsuke, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan.
Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan.
Clin Microbiol Infect. 2023 Jul;29(7):904-910. doi: 10.1016/j.cmi.2023.04.006. Epub 2023 Apr 10.
The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in preventing pneumonia in older adults remains controversial. Some studies have suggested differences in their effectiveness according to age or sex.
We conducted an observational study using a database of vaccine subsidization data and health insurance claims for a city in Japan. Participants were residents from 2014 to 2018 turning 65, 70, 75, 80, 85, 90, or 95 years during a given fiscal year, and PPV23 during the first year of observation were identified. We matched vaccinated and non-vaccinated individuals of the same age using propensity scores for vaccination. The incidence of hospitalization with pneumonia was compared using the Fine-Gray regression model. We summarized the results for each age using random-effects meta-analysis and conducted a subgroup analysis by sex.
A total of 102 136 participants were included, of whom 35% received PPV23. Propensity score matching selected 32 510 pairs of vaccinated and non-vaccinated individuals. Overall, PPV23 administration was associated with a decreased incidence of hospitalization with pneumonia (17.2 vs. 20.4 per 1000 person-years, sub-distribution hazard ratio: 0.84, 95% CI: 0.77 to 0.91). Vaccine effectiveness was the highest among those aged 70 years and decreased with increasing age. No statistically significant effect was observed in those aged 90 or 95 years. Vaccine effectiveness was observed in both males and females.
PPV23 was associated with an overall decrease in hospitalization with pneumonia in older adults. However, vaccine effectiveness was significant in those aged 65 to 85 years but not in the older population.
23 价肺炎球菌多糖疫苗（PPV23）预防老年人肺炎的效果仍存在争议。一些研究表明，其效果可能因年龄或性别而异。
我们使用日本某城市的疫苗补贴数据和健康保险理赔数据库进行了一项观察性研究。参与者为在特定财政年度年满 65、70、75、80、85、90 或 95 岁的居民，且在观察的第一年接种了 PPV23。我们使用倾向评分匹配了相同年龄的接种者和未接种者。使用 Fine-Gray 回归模型比较肺炎住院的发生率。我们使用随机效应荟萃分析总结了每个年龄的结果，并按性别进行了亚组分析。
共纳入 102136 名参与者，其中 35%接种了 PPV23。倾向评分匹配选择了 32510 对接种者和未接种者。总体而言，PPV23 接种与肺炎住院发生率降低相关（每 1000 人年 17.2 例与 20.4 例，亚分布危险比：0.84，95%CI：0.77 至 0.91）。70 岁年龄组的疫苗有效性最高，随年龄增长而降低。90 岁或 95 岁年龄组未见统计学意义。疫苗有效性在男性和女性中均观察到。
PPV23 与老年人肺炎住院总体减少相关。然而，疫苗有效性在 65 至 85 岁年龄组显著，但在老年人群中不显著。
