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Socioeconomic and Racial Disparities of Pediatric Invasive Pneumococcal Disease After the Introduction of the 7-valent Pneumococcal Conjugate Vaccine

Spicer, Jennifer O. MD, MPH; Thomas, Stephanie MPH; Holst, Amy MPH; Baughman, Wendy MPH; Farley, Monica M. MD*‡

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p 158–164
doi: 10.1097/INF.0000000000000025
Original Studies

Background: Racial differences have been well described for invasive pneumococcal disease (IPD), but little information exists on how race interacts with community socioeconomic factors.

Methods: The Active Bacterial Core surveillance/Emerging Infections Program performed active surveillance for IPD in the 20-county Metropolitan Atlanta area. All IPD cases among children younger than 5 years from 2001 to 2009 were geocoded and linked to census tract-level socioeconomic measures from the 2000 US Census. Race- and socioeconomic-specific average annual incidence rates per 100,000 population were calculated. Trends in IPD incidence were determined by χ2 tests for trend. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression.

Results: IPD incidence among the total population of children increased as percentage of household poverty increased (P = 0.002), as median household income decreased (P < 0.001), as wealth decreased (P = 0.018) and as percentage of individuals with less than a high school education increased (P = 0.023). After stratifying by race, there was no significant linear trend between socioeconomic characteristics and IPD incidence among white children; among black children, however, IPD incidence decreased as socioeconomic conditions worsened. Despite adjusting for sex and socioeconomic factors, the IPD rate remained higher among black children compared with white children (RR = 1.60; 95% CI: 1.39–1.84). Differences in RR of IPD associated with highest poverty and lowest wealth noted in 2001 [RR = 2.71 (95% CI: 2.17–3.39) and 1.80 (95% CI: 1.09–2.96), respectively] declined in 2009 [RR = 1.33 (95% CI: 0.90–1.96) and 0.76 (95% CI: 0.48–1.19), respectively].

Conclusions: Although socioeconomic disparities in IPD incidence exist among children, the association between socioeconomic characteristics and IPD rates may differ by race and may change over time. Community-level socioeconomic factors did not account for racial differences in IPD incidence.

Supplemental Digital Content is available in the text.

From the *Department of Medicine, Emory University School of Medicine, Atlanta, GA; Department of Medicine, Atlanta Research and Education Foundation, Decatur, GA; and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA.

Accepted for publication August 22, 2013.

This study was funded in part by the Centers for Disease Control and Prevention’s Emerging Infections Program, Atlanta, GA.

The authors have no conflicts of interest to disclose.

This work was presented in part at the 52nd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, September 2012.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Monica M. Farley, MD, Department of Medicine, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.