Clinical burden of pneumococcal disease among adults in France: A retrospective cohort study

Pneumococcal disease (PD) is associated with high morbidity and mortality, specifically among individuals ≥65 years of age and those with underlying medical conditions (UMCs). This retrospective cohort study estimated the clinical burden of PD in adults ≥18 years of age with or without UMCs in France. Data were obtained from the French National Health Data System for four yearly cohorts (1 January 2015-31 December 2018). Characteristics of patients with UMCs, with or without PD (UMC population), and the incidence rate and lethality rate of PD leading to hospitalization (in-patient PD population), stratified by age and risk status, were described. In the UMC population (n = 7,947,622; mean age: 65 years), the incidence rate of in-patient PD episodes was 121.98 per 100,000 person-years and was highest among individuals ≥65 years of age (138.52) and in those considered medium-risk (102.45) or high-risk (165.77). In the in-patient PD population (n = 41,885), 59.6% were ≥65 years of age; 1-year all-cause mortality following the initial in-patient PD episode was 26.5%. Individuals ≥65 years of age (regardless of risk status) had a higher risk of PD leading to hospitalization than individuals 18-64 years of age. This study shows a high burden of PD in France due to in-patient PD among adults with UMCs, particularly in those ≥65 years of age, despite their eligibility for pneumococcal vaccination. This highlights the need for higher vaccination coverage, supported by the recent extension of vaccination to all people ≥65 years of age, regardless of their health risk status.