Social Determinants of Health Impact Burden of Pneumococcal Disease

Pneumococcal disease, a serious bacterial infection caused by Streptococcus pneumoniae, remains a leading cause of morbidity and mortality in the United States despite being largely preventable through vaccination. A recent targeted literature review published in Pneumonia highlights the burden of pneumonia, which is significantly shaped by social determinants of health. These can include race, urbanicity, and socioeconomic status.¹

“Considering the role and impact of the SDoH [social determinants of health] on pneumococcal disease and vaccination coverage can help health authorities identify health inequities and develop interventions aimed to reduce disparities and improve overall health and well-being,” the study authors said.

For pharmacists, who often serve as the most accessible health care providers in their communities, understanding these disparities is critical for improving vaccine equity and patient outcomes.

Black adults experience the highest incidence and mortality rates of pneumococcal disease across all adult age groups. Of particular importance for community pharmacists is the finding that Black patients are more likely to be hospitalized at younger ages—specifically between 50 and 64 years—compared with nonBlack adults.

These hospitalizations are not only more frequent but also more resource-intensive. Black adults hospitalized for pneumococcal disease face longer hospital stays and significantly higher costs, averaging over $20,733 per stay compared with $17,844 for nonBlack patients.

Geography and environment further complicate the landscape of infection. Mortality rates for adults with pneumonia are notably higher in rural areas compared with urban centers. This environmental disparity extends to prevention efforts, as vaccination rates are consistently lower among rural residents.

Socioeconomic status (SES) remains one of the strongest predictors of both disease risk and vaccine uptake. Adults living in disadvantaged areas or high-poverty neighborhoods have a higher risk of being hospitalized for invasive pneumococcal disease, and those with higher income, home ownership, and higher educational attainment are significantly more likely to be vaccinated.

The COVID-19 pandemic added another layer of complexity to these existing inequities. Research published in Vaccine indicates that although vaccination disparities narrowed for Medicare enrollees during the pandemic—likely due to intensive outreach and a heightened perception of respiratory risk—disparities actually widened for Medicaid enrollees. This gap for low-income, younger adults was likely exacerbated by pandemic-related lockdowns that limited public transportation and intensified economic barriers, making health care access even more difficult for the most vulnerable populations.²

Pharmacists are in a unique position to address these challenges, especially following the CDC Advisory Committee on Immunization Practices' 2024 decision to lower the routine vaccination age to 50 years. This policy change is a direct tool to reach vulnerable populations, such as Black adults, who are hit by severe disease earlier in life.^1,3

However, pharmacists must also navigate structural barriers that hinder uptake. Studies suggest that unvaccinated racial and ethnic minorities often face practical hurdles like difficulty scheduling appointments, lack of transportation, and limited access to digital patient portals that provide essential health education.

“Further research is needed to assess the impact of this updated recommendation,” the study authors said.¹ “Additionally, gaining a deeper understanding of the barriers to vaccination and association with characteristics for which disparities were observed is essential for designing solutions to overcome these challenges.”

Public health initiatives must be tailored to address individual- and area-level vulnerabilities. Pharmacists can play a pivotal role by identifying patients with high-risk comorbidities who live in socially vulnerable areas and providing amplified risk messaging. By recognizing that factors such as job type—with blue-collar workers showing lower vaccination rates than those in sales or office roles—and housing stability influence a patient's health journey, pharmacists can move beyond simple administration to become advocates for true health equity.²

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Cossrow N, Mohanty S, Johnson KD, et al. Health disparities in the burden of pneumococcal disease in US adults. Pneumonia (Nathan). 2026;18(1):11. Published 2026 Apr 7. doi:10.1186/s41479-026-00197-z

2. Mohanty S, Zurovac J, Barna M, et al. Changes in pneumococcal vaccination disparities by area-level social vulnerability during the COVID-19 pandemic among Medicare and Medicaid enrollees. Vaccine. 2025;62:127452. doi:10.1016/j.vaccine.2025.127452

3. CDC. About pneumococcal disease. February 24, 2026. Accessed April 9, 2026. https://www.cdc.gov/pneumococcal/about/index.html