Trends and determinants of pneumococcal vaccine uptake among U.S. adults, 2019-2024: a pooled cross-sectional...

Pneumococcal disease causes substantial morbidity and mortality among U.S. adults, with an estimated 20,000 deaths and 150,000 hospitalizations annually. Despite effective vaccines, coverage has remained below national targets. Pandemic-related disruptions and the 2022 Advisory Committee on Immunization Practices transition to simplified 15/20 valent Pneumococcal Conjugate Vaccine recommendations may have influenced uptake, but their impact has not been fully assessed. To address this gap, this study examines trends and determinants of pneumococcal vaccine uptake among U.S. adults following the pandemic and 2022 guideline changes.

We conducted a pooled cross-sectional analysis of National Health Interview Survey data from 2019 to 2024, including 166,948 adults aged ≥ 18 years with complete data. Weighted bivariate analyses assessed associations between vaccination uptake and demographic (age, sex, race/ethnicity), socioeconomic (education, income, citizenship), health-related (chronic conditions including Chronic Obstructive Pulmonary Disease, diabetes, asthma, and cancer; smoking; influenza vaccination), and healthcare access factors (insurance, usual source of care, recent provider visit). Multivariable logistic regression identified independent predictors of vaccination. All analyses incorporated National Health Interview Survey complex survey design and sampling weights.

Overall weighted pneumococcal vaccination coverage remained low, fluctuating between 29.6% and 33.2% across survey years. Coverage was highest among adults aged ≥ 65 years (65.7%) but remained substantially below the Healthy People 2020 goal of 90%. Only 23.0% of adults aged 55-64 years reported vaccination despite risk-based recommendations. Disparities persisted across racial/ethnic groups, with Hispanic adults showing the lowest uptake (13.9%) compared to non-Hispanic White adults (29.1%). In adjusted analyses, age ≥ 65 years (odds ratio [OR] = 9.39; 95% confidence interval [CI]: 8.84-9.96), chronic conditions including Chronic Obstructive Pulmonary Disease (OR = 2.04; 95% CI: 1.90-2.20) and diabetes (OR = 1.84; 95% CI: 1.74-1.95), recent healthcare visits (OR = 1.41; 95% CI: 1.31-1.51), and influenza vaccination were strong independent predictors of uptake. Lack of insurance (OR = 0.89; 95% CI: 0.81-0.98), absence of a usual source of care (OR = 0.81; 95% CI: 0.74-0.88), and non-receipt of influenza vaccine (OR = 0.29; 95% CI: 0.28-0.30) were associated with lower odds of vaccination.

Pneumococcal vaccination coverage among U.S. adults remained stagnant from 2019 to 2024, with persistent gaps among younger high-risk adults and racial/ethnic minorities. Healthcare engagement, insurance, provider contact, and influenza vaccination, were strongly associated with uptake. These findings suggest that risk-based screening, provider recommendations, and improved access for underserved populations may help address coverage gaps.