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Changes in Childhood Pneumonia Hospitalizations by Race ... · PDF fileperformed by using STATA version 14 (StataCorp LP, College Station, TX, USA). Pneumonia hospitalization rates

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Andrew D. Wiese, Carlos G. Grijalva, Yuwei Zhu, Edward F. Mitchel Jr, Marie R. Griffin

Introduction of pneumococcal conjugate vaccines in the childhood immunization schedule was associated with de-creases in all-cause pneumonia hospitalizations among black and white children in Tennessee, USA. Although ra-cial disparities that existed before introduction of these vac-cines have been substantially reduced, rates remain higher in boys than in girls among young children.

Introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) into the childhood immunization sched-ule was associated with substantial reductions in invasive pneumococcal disease (IPD) and pneumonia in young children in the United States and elsewhere (14). In the United States specifically, black children traditionally had higher IPD and pneumonia rates than white children. How-ever, this racial disparity in IPD was reduced after introduc-tion of PCV7 (5).

After the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010, IPD and pneumonia hospitalizations among children


black boys also decreased but were still higher than rates for white boys (RR 1.12, 95% CI 1.051.20) during the post-PCV13 period.

For children


generalized changes in hospitalization practices in Tennes-see (2). Third, other factors, such as socioeconomic char-acteristics or concurrent conditions, could contribute to ob-served differences between racial and sex groups. However, our study did not account for those factors. Fourth, because

our study documents changes for only children in Tennes-see, caution is warranted when extrapolating our findings to other settings.

Overall, these findings suggest that PCV7 and PCV13 have substantially reduced racial disparities in all-cause pneumonia between black and white children in Tennes-see that existed before PCVs, especially among children


6. Farnham AC, Zimmerman CM, Papadouka V, Konty KJ, Zucker JR, Nattanmai GV, et al. Invasive pneumococcal disease following the introduction of 13-valent conjugate vaccine in children in New York City from 2007 to 2012. JAMA Pediatr. 2015;169:64652.

7. de St Maurice A, Grijalva CG, Fonnesbeck C, Scahffner W, Halasa NB. Racial and regional differences in rates of invasive pneumococcal disease. Pediatrics. 2015;136:e118694.

8. Spicer JO, Thomas S, Holst A, Baughman W, Farley MM. Socioeconomic and racial disparities of pediatric invasive pneumococcal disease after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2014;33:15864.

9. Muenchhoff M, Goulder PJ. Sex differences in pediatric infectious diseases. J Infect Dis. 2014;209(Suppl 3):S1206. 10.1093/infdis/jiu232

10. Guevara RE, Butler JC, Marston BJ, Plouffe JF, File TM, Breiman RF. Accuracy of ICD-9-CM codes in detecting community-acquired pneumococcal pneumonia for incidence and

vaccine efficacy studies. Am J Epidemiol. 1999;149:2829. 10.1093/oxfordjournals.aje.a009804

11. Williams DJ, Shah SS, Myers A, Hall M, Auger K, Queen MA, et al. Identifying pediatric community-acquired pneumonia hospi-talizations: accuracy of adminstrative billing codes. JAMA Pediatr. 2013;167:8518.

12. Del Principe D, Mtarrese P, Villani A, Malorni W. Gender disparity in pediatric diseases. Curr Mol Med. 2013;13:499513.

13. Zhou F, Kyaw MH, Shefer A, Winston CA, Nuorti JP. Health care utilization for pneumonia in young children after routine pneumococcal conjugate vaccine use in the United States. Arch Pediatr Adolesc Med. 2007;161:11628.

Address for correspondence: Andrew D. Wiese, Department of Health Policy, Vanderbilt University Medical Center, 1500 21st Ave S, 2600 Village at Vanderbilt, Nashville, TN 37212, USA; email: [email protected]


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