Impact of pneumococcal polysaccharide vaccine on incidence and mortality after pneumonia in adults aged ≥ 60 years – a population-based retrospective cohort study

Martin Kolditz, Jochen Schmitt, Mathias W. Pletz, and Falko Tesch

Supplementary material

  • Table S1: Definition of chronic comorbidities
  • Table S2: Balance of covariates before and after matching on PPV vaccination within 5 years of n=213.431 vaccinated adults ≥ 60 years and n=525.496 non-vaccinated adults ≥ 60 years for evaluation of pneumonia incidence
  • Table S3: Balance of covariates before and after matching on PPV vaccination within 5 years of n =7501 vaccinated adults ≥ 60 years with pneumonia and n=15.437 non-vaccinated adults ≥ 60 years with pneumonia for evaluation of 30-day all-cause mortality after pneumonia
  • Figure S1: Density of the propensity score for 30 day all-cause mortality for PPV-vaccinated individuals (treated) and non PPV-vaccinated individuals (controls) before (left) and after matching (right).
  • Table S4: Time-dependent effectiveness of PPV vaccination according to propensity score based multivariate analysis and year of vaccination with standard confidence interval

Table S1: Definition of chronic comorbidities

Comorbidity group / Corresponding ICD-10-GM codes
Chronic cardiovascular disease / I21, I22, I25.2, A52.0, I05, I06, I07, I08, I09.1, I09.8, I09.9, I11.0, I13.0, I13.2, I25.5, I27.0, I27.2, I34, I35, I36, I37, I38, I39, I42.0, I42.5, I42.6, I42.7, I42.8, I42.9, I50, P29.0, Q23.0, Q23.1, Q23.2, Q23.3, Z95.2, Z95.3, Z95.4, I71, I73.1, I73.8, I73.9, I77.1, I79.0, I79.2, K55.1, K55.8, K55.9, Z95.8, Z95.9
Chronic cerebrovascular or neurologic disease / G10, G11, G12, G13, G20, G21, G22, G25.4, G25.5, G31.2, G31.8, G31.9, G32, G35, G36, G37, G40, G41, G45, G46, G93.1, G93.4, H34, I60, I61, I62, I63, I64, I65, I66, I67, I68, I69, R47.0, R56, F00, F01, F02, F03, F05.1, G30, G31.1, G40.1, G11.4, G80.1, G80.2, G81, G82, G83.0, G83.1, G83.2, G83.3, G83.4, G83.9
Chronic lung disease / J43, J44, J45, J46, J47, J60, J61, J62, J63, J64, J65, J66, J67, J68.4, J70.1, J70.3, J84, D86.0, D86.2
Chronic renal disease / I12.0, I13.1, N03.2, N03.3, N03.4, N03.5, N03.6, N03.7, N05.2, N05.3, N05.4, N05.5, N05.6, N05.7, N18, N19, N25.0, Z49.0, Z49.2, Z94.0, Z99.2
Chronic gastrointestinal or liver disease / K50, K51, B18, K70.2, K70.3, K70.4, K71.1, K71.3, K71.4, K71.5, K71.7, K72.1, K72.9, K73, K74, K76.1, K76.2, K76.3, K76.4, K76.5, K76.6, K76.7, I85.0, I85.9, I86.4, I98.2, Z94.4
Diabetes mellitus / E10.0, E10.1, E10.6, E10.8, E10.9, E11.0, E11.1, E11.6, E11.8, E11.9, E12.0, E12.1, E12.6, E12.8, E12.9, E13.0, E13.1, E13.6, E13.8, E13.9, E14.0, E14.1, E14.6, E14.8, E14.9, E10.2, E10.3, E10.4, E10.5, E10.7, E11.2, E11.3, E11.4, E11.5, E11.7, E12.2, E12.3, E12.4, E12.5, E12.7, E13.2, E13.3, E13.4, E13.5, E13.7, E14.2, E14.3, E14.4, E14.5, E14.7
Chronic rheumatoid disease / M05, M06, M30, M31, M32, M33, M34, M35.0-6, M36.0, L94.0, L94.1, L94.3, M08, M12.0, M12.3, M45, M46.1, M46.8, M46.9
Malignant disease / C00, C01, C02, C03, C04, C05, C06, C07, C08, C09, C10, C11, C12, C13, C14, C15, C16, C17, C18, C19, C20, C21, C22, C23, C24, C25, C26, C30, C31, C32, C33, C34, C37, C38, C39, C40, C41, C43, C45, C46, C47, C48, C49, C50, C51, C52, C53, C54, C55, C56, C57, C58, C60, C61, C62, C63, C64, C65, C66, C67, C68, C69, C70, C71, C72, C73, C74, C75, C76, C81, C82, C83, C84, C85, C88, C90, C91, C92, C93, C94, C95, C96, C97, C77, C78, C79, C80
Chronic immunosuppressive disease / B20, B21, B22, B24, D57, D70.0, D70.3, D70.5, D70.6, D70.7, D71, D72, D73.0, D80, D81, D82, D83, D84, D89.1, D89.3, D89.8, D89.9, D90, Q89.0, Z21, G97.80, Z96.2, Z94.80, Z94.81, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4

Table S2: Balance of covariates before and after matching on PPV vaccination within 5 years of n=213.431 vaccinated adults ≥ 60 years and n=525.496 non-vaccinated adults ≥ 60 years for evaluation of pneumonia incidence (for each individual with PPV vaccination three controls were matched with replacement on the propensity score and exact on influenza vaccination status)

Characteristic, (%) / Vaccinated
n=213.431 / Non vaccinated
before matching
n=525.496 / Non vaccinated after matching
n=640.293
Age, Mean / 76.40 / 73.87 / 76.68
Influenza vaccination / 164.486 (77.07) / 243.504 (46.34) / 493.458 (77.07)
Male sex / 82.030 (38.43) / 216.840 (41.26) / 239.726 (37.44)
Cardiovascular diseases / 64.417 (30.18) / 124.096 (23.62) / 188.886 (29.50)
Cerebrovascular/neurologic diseases / 62.553 (29.31) / 132.330 (25.18) / 195.545 (30.54)
Lung diseases / 40.301 (18.89) / 71.149 (13.54) / 111.283 (17.38)
Malignant diseases / 27.727 (12.99) / 56.442 (10.74) / 80.101 (12.51)
Rheumatoid diseases / 13.855 (6.49) / 26.018 (4.95) / 38.802 (6.06)
Renal diseases / 35.619 (16.69) / 66.880 (12.73) / 109.274 (16.91)
Gastrointestinal/liver diseases / 5.226 (2.45) / 12.161 (2.31) / 15.495 (2.42)
Diabetes mellitus / 89.737 (42.05) / 176.662 (33.62) / 276.671 (43.21)
Immunosuppressive diseases / 2881 (1.35) / 5584 (1.08) / 7876 (1.23)
Nursing home residence / 9482 (4.44) / 21.723 (4.13) / 33.615 (5.25)

Table S3: Balance of covariates before and after matching on PPV vaccination within 5 years of n=7501 vaccinated adults ≥ 60 years with pneumonia and n=15.437 non-vaccinated adults ≥ 60 years with pneumonia for evaluation of 30-day all-cause mortality after pneumonia (for each individual with PPV vaccination three controls were matched with replacement on the propensity score and exact on influenza vaccination status)

Characteristic, (%) / Vaccinated
n=7501 / Non vaccinated before matching
n=15.437 / Non vaccinated after matching n=22.503
Age,Mean / 80.14 / 79.29 / 80.29
Influenza vaccination / 5693 (75.90) / 8304 (53.79) / 17.080 (75.90)
Male sex / 3600 (47.99) / 7283 (47.18) / 10.860 (48.26)
Cardiovascular diseases / 4107 (54.75) / 8025 (51.99) / 12.388 (55.05)
Cerebrovascular/neurologic diseases / 4190 (55.86) / 8978 (58.16) / 12.714 (56.50)
Lung diseases / 2920 (38.93) / 5215 (33.78) / 8763 (38.94)
Malignant diseases / 1450 (19.33) / 2846 (18.44) / 4422 (19.65)
Rheumatoid diseases / 554 (7.39) / 1005 (6.51) / 1661 (7.38)
Renal diseases / 2751 (36.68) / 5236 (33.92) / 8279 (36.79)
Gastrointestinal/liver diseases / 314 (4.19) / 685 (4.44) / 1017 (4.52)
Diabetes mellitus / 3946 (52.61) / 7530 (48.78) / 11.886 (52.82)
Immunosuppressive diseases / 264 (3.52) / 476 (3.08) / 812 (3.61)
Nursing home residence / 762 (10.16) / 1717 (11.12) / 2410 (10.71)

Figure S1: Density of the propensity score for 30 day all-cause mortality for PPV-vaccinated individuals (treated) and non PPV-vaccinated individuals (controls) before (left) and after matching (right).

Table S4: Time-dependent effectiveness of PPV vaccination according to propensity score based multivariate analysis and year of vaccination with standard confidence interval

Last PPV vaccination / Events vaccinated (%) / Events controls (three per case, %) / Difference / 95 % CI Interval / p value
Two-year incidence of pneumonia, all individuals
Within 0-1 year / 928/25.362 (3.66) / 2640/76.086 (3.47) / 0.20 / -0.12-0.52 / 0.230
Within 1-2 years / 1191/33.494 (3.56) / 3477/100.482 (3.46) / 0.10 / -0.17-0.38 / 0.474
Within 2-3 years / 1531/41.646 (3.68) / 4298/124.938 (3.44) / 0.24 / -0.12-0.49 / 0.062
Within 3-4 years / 1870/56.781 (3.29) / 6252/170.343 (3.67) / -0.38 / -0.59--0.17 / 0.004
Within 4-5 years / 1981/56.188 (3.53) / 6271/168.564 (3.72) / -0.20 / -0.41-0.02 / 0.073
30-day all-cause mortality after pneumonia, all individuals
Within 0-1 year / 161/928 (17.35) / 508/2784 (18.25) / -0.90 / -4.32-2.53 / 0.607
Within 1-2 years / 224/1191 (18.81) / 664/3573 (18.58) / 0.22 / -2.90-3.35 / 0.888
Within 2-3 years / 226/1531 (14.76) / 810/4593 (17.13) / -2.37 / -4.97-0.23 / 0.074
Within 3-4 years / 333/1870 (17.81) / 1068/5610 (19.04) / -1.23 / -3.70-1.24 / 0.328
Within 4-5 years / 358/1981 (18.07) / 1115/5943 (18.76) / -0.69 / -3.08-1.70 / 0.572
30-day all-cause mortality after pneumonia, Age group 60-79 years
Within 0-1 year / 43/443 (9.71) / 144/1329 (10.84) / -1.13 / -5.09-2.84 / 0.577
Within 1-2 years / 57/544 (10.48) / 201/1632 (12.32) / -1.84 / -5.57-1.89 / 0.334
Within 2-3 years / 63/739 (8.53) / 248/2217 (11.19) / -2.66 / -5.78-0.46 / 0.095
Within 3-4 years / 96/883 (10.87) / 332/2649 (12.53) / -1.66 / -4.65-1.33 / 0.276
Within 4-5 years / 101/881 (11.47) / 352/2643 (13.32) / -1.85 / -5.00-1.30 / 0.250