Clinical, Economic Burden of Pneumococcal Disease Consistent Across Age Groups


Investigators found that younger age groups had significantly longer lengths of stay compared to those older than 75 years.

Invasive pneumococcal disease (IPD) and non-invasive all-cause pneumonia (ACP) have been associated with substantial clinical and economic burden for adults in the United States, even across age groups, according to results of a study published in International Journal of Infectious Diseases. Investigators said that expanded pneumococcal vaccination could help to reduce disease burden as well as decrease costs for hospitals.

Streptococcus pneumonia bacteria cells. | Image Credit: Jezper -

Image Credit: Jezper -

Investigators of the study aimed to determine the clinical and economic burden of pneumococcal disease. They evaluated in-hospital mortality, length of stay, cost per admission, and hospital margins, according to the study authors. The study was retrospective in nature, including data from 90 hospitals in the United States representing both small and large hospitals in urban and rural areas. Administrative data and orders for antimicrobial agents were collected between October 2016 and February 2020, according to the study authors.

Outcomes of interest included length of stay and in-hospital mortality, while economic outcomes included total costs for patient care as well as all payments received by the hospital, including from insurance.

Investigators included 88,182 individuals, approximately 98.6% of whom had non-invasive ACP and the remaining had IPD. Additionally, approximately 1.6% had a positive S. pneumoniae culture and 0.6% had a positive urine antigen test, according to the study authors. Of the 1450 individuals with a positive culture for S. pneumoniae, 37.7% were resistant to at least 1 tested antibiotic. Of note, approximately 15.2% were in the 18 to 49 age group and 25% were in the 50 to 64 age group, according to the study authors.

In the unadjusted analysis, the overall observed in-hospital mortality rate was 8.3%, although there was a wide standard deviation of length of stay, cost per admission, and hospital margins, so the study authors reported median values.

The median length of stay was 6 days, the median cost per admission was $9791, and the median hospital margin per admission was $11, according to the study authors. Older age was associated with higher mortality, although median length of stay and hospital costs per admission were observed across age groups in the unadjusted analysis.

In the adjusted analysis, in-hospital mortality was most associated with admission to the intensive care unit and an age older than 75 years. Other variables included ages 50 to 75 years, prior 90-day admission, or Medicare, worker’s compensation, and Veterans’ Affairs insurance. For length of stay and higher costs, ICU admission was also associated with the greatest impact, according to the study authors. Other significant variables included IPD, no culture or a negative culture, being male, a prior 90-day admission, and being moderate or high risk for pneumococcal disease, according to the study results.

Key Takeaways

  1. Both invasive pneumococcal disease (IPD) and non-invasive pneumonia were prevalent across all adult age groups, with a substantial burden on hospitals.
  2. Pneumococcal disease was associated with increased in-hospital mortality, longer hospital stays, and higher costs compared to other admissions.
  3. The 18-49 age group had the longest hospital stays and highest costs, despite lower mortality rates compared to older adults.

Investigators also found that individuals in the 18 to 49 age group had significantly longer length of stay compared to those older than 75 years. They also had significantly higher hospital costs per admission than all other age groups, according to the study authors.

Furthermore, investigators reported that in the subgroup with positive S. pneumoniae, the results were generally consistent with those in the overall patient cohort. They found this to be true for length of stay, in-hospital mortality, and economic outcomes, according to the analysis results.


Mohanty S, Cossrow N, Yu KC, Ye G, White M, Gupta V. Clinical and economic burden of invasive pneumococcal disease and non-invasive all-cause pneumonia in hospitalized US adults: A multicenter analysis from 2015-2020. Int J Infect Dis. 2024. doi:10.1016/j.ijid.2024.107023

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