Commercially Insured US Adults Show Distinct Age-Specific Pneumococcal Disease Risk Profiles

A retrospective observational study of commercially insured adults in the United States found that 58.4 percent were classified as low risk for pneumococcal disease, while 28.1 percent faced moderate risk and 13.5 percent were at high risk in 2022. The investigation analyzed individuals aged 18 years and older enrolled in the IBM MarketScan Commercial Claims and Encounters database to evaluate the distribution of risk conditions across single-year age cohorts. While individuals categorized as low risk and moderate risk were predominantly between 18 and 49 years of age, the high-risk group was primarily comprised of adults aged 50 to 64 years and females.

The overall study population exhibited distinct demographic characteristics, comprising more females at 52.2 percent than males at 47.8 percent. A majority of the analyzed individuals, representing 55.5 percent of the cohort, were aged 18 to 49 years. In terms of geographic distribution within the United States, participants were most likely to reside in the South region, which accounted for 44.9 percent of the total enrolled population.

Clinical risk classifications were established using International Classification of Diseases, Clinical Modification version 10 codes and Current Procedural Terminology version 4 codes based on the Advisory Committee on Immunization Practices framework. Across the clinical categories, chronic lung disease and chronic heart disease were identified as the most prevalent conditions among adults classified as moderate risk. In contrast, cancer emerged as the most prevalent condition among individuals placed in the high-risk category. Risk assignments in the primary analysis were derived from a five-year lookback period among individuals who maintained continuous health plan enrollment.

Sensitivity analyses conducted by the researchers revealed consistent age-related patterns when altering the primary study parameters, although classification proportions varied. Evaluating cohorts using a shorter two-year lookback period or removing the continuous enrollment requirement resulted in lower proportions of adults being classified into the moderate-risk or high-risk categories compared to the primary five-year continuous enrollment approach. In addition to single-year cohort evaluations, supplementary analyses summarized risk distributions across broader age categories.

The investigators noted that pneumococcal disease carries substantial health and economic burden in the United States, where Advisory Committee on Immunization Practices guidelines recommend vaccination for adults with immunocompromising and chronic medical conditions. According to the study authors, these single-age cohort findings address an existing evidence gap by delivering descriptive risk estimates for commercially insured adults. The authors concluded that these descriptive data may help contextualize age-specific risk patterns, support future economic and epidemiological modeling, and inform hypothesis generation regarding pneumococcal disease risk across adult age groups.

Subject of Research: Pneumococcal disease risk distribution among commercially insured US adults

Article Title: Single age cohort health risk distribution of pneumococcal disease among US adults in 2022

Article References: Simuzingili, M., Zheng, Y., Ai, L., Huang, A., & Owusu-Edusei, K. (2026). Single age cohort health risk distribution of pneumococcal disease among US adults in 2022. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14519-5

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14519-5

Keywords: pneumococcal disease, health risk distribution, adult vaccination, observational study, chronic conditions, commercial insurance, ACIP guidelines, epidemiology, Single, cohort, health, risk