Influence of area-level social vulnerability on all-cause pneumonia incidence among adult Medicare and Medicaid enrollees

Abstract

Background

The incidence of pneumonia varies by demographic and clinical factors, but less is known about the influence of area-level social determinants of health.

Methods

Using Medicare and Medicaid claims, we characterized the relationship between the county-level Minority Health Social Vulnerability Index (MHSVI) and all-cause pneumonia (ACP), pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) incidence from 2016 to 2019.

Results

We show that in Medicare ( ≥ 65 years, 55% female) and Medicaid (ages 19–64, 58% female), ACP incidence is 8052 and 1819 per 100,000 person-years, respectively. Across both cohorts, rates are highest among enrollees who are male, non-Hispanic white, older, at high risk for pneumococcal disease (those with immunocompromising or other serious conditions such as cancer), and rural county residents. Among high-risk Medicare and Medicaid enrollees, ACP incidence is higher in the most versus least socially vulnerable counties, whereas the opposite is observed among moderate-risk enrollees (those with chronic conditions such as diabetes) and low-risk enrollees (those without chronic or immunocompromising conditions).

Conclusions

Controlling for individual characteristics attenuated the relationship between vulnerability and disease incidence overall and in most subgroups. Within MHSVI themes, ACP incidence is higher for the most versus least vulnerable counties based on Medical Vulnerability and Household Composition and Disability themes versus the overall MHSVI. Results for secondary outcomes (PP and IPD) follows similar patterns as for ACP but are weaker in magnitude and significance.

Mohanty et al. examine the link between county-level Minority Health Social Vulnerability Index and rates of all-cause pneumonia, pneumococcal pneumonia, and invasive pneumococcal disease from 2016 to 2019 among publicly insured U.S. adults. Findings show that pneumococcal disease rates are higher in the most socially vulnerable counties.