Changes in pneumococcal deaths in the United States following the COVID-19 pandemic
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Background
Although changes in the rates of pneumococcal cases during the COVID-19 pandemic have been extensively described, changes in rates of death due to pneumococcus during this period are not well understood.
Methods
We obtained vital statistics data for the United States (National Center for Health Statistics), including age, sex, race/ethnicity, cause of death (ICD-10), 2014-2022. Generalized linear models were fit to the period from January 2014-February 2020 and extrapolated to March 2020-December 2022 to generate an expected number of pneumococcal deaths and a 95% prediction interval. We used a lasso regression model to identify clinical and demographic factors most strongly associated with pneumococcal deaths during the pandemic period as compared with a pre-pandemic baseline.
Results
For most of 2020, pneumococcal deaths were not notably different from the pre-pandemic period and largely followed the typical seasonal pattern. However, at the end of 2020 and early 2021, when pneumococcal deaths would typically peak, the rates of death remained lower than normal and stayed lower than expected in the spring of 2021. Starting around mid-2021, there was a notable spike above baseline that coincided with the Delta wave of COVID-19. The 2021 winter – 2022 spring peak followed the pre-pandemic trend. Some of the changes could be attributed to changes in the seasonality of respiratory viruses that interact with pneumococcus. The prevalence of certain risk factors among pneumococcal deaths elevated following the pandemic, including obesity (OR = 1.40), diabetes mellitus without complication (OR = 1.39) and heart failure (OR = 1.31).
Conclusions
The COVID-19 pandemic significantly disrupted pneumococcal mortality patterns in ways that were distinct from the changes described in clinical cases of invasive pneumococcal disease.
Key points
COVID-19 pandemic significantly disrupted pneumococcal mortality patterns. Respiratory viruses are important trigger for pneumococcal diseases.
