title: A population-based analysis of pneumococcal disease mortality in California, 1989-1998.
abstract: OBJECTIVE
  Pneumococcal disease is an important cause of vaccine-preventable mortality. It is important to understand the burden and distribution of mortality so that prevention efforts can be targeted appropriately. This study evaluated pneumococcal disease mortality and its demographic correlates in California from 1989 to 1998.
  
  
  METHODS
  Deaths due to pneumococcal disease were identified from statewide vital records data using multiple cause-coded information. Denominator data were obtained from estimates from the California Department of Finance. Crude and age-adjusted mortality rates and 95% confidence intervals were calculated for each age, gender, and racial/ethnic group.
  
  
  RESULTS
  The age-adjusted pneumococcal disease mortality rate was 2.05 deaths per 100,000 population. Mortality was highest in elderly individuals (reaching 38.29 deaths per 100,000 population in individuals older than age 85). Age-adjusted mortality rates were elevated in the African American race/ethnicity group (2.96 deaths per 100,000 population) and males (2.67 deaths per 100,000 population). The majority of individuals who died of pneumococcal disease (78.9%) fell into at-risk groups indicated for vaccination. The majority of all pneumococcal deaths were caused by pneumococcal pneumonia. Mortality was seasonal, reaching a peak in the winter months. A decreasing trend in mortality was observed over the 10-year period examined.
  
  
  CONCLUSIONS
  Pneumococcal disease remains a significant cause of vaccine-preventable mortality in the California population. Greater efforts must be made to vaccinate at-risk individuals, especially those in demographic groups at highest risk of death.
authors.affiliation: Los Angeles County Department of Health Services, Los Angeles, CA, USA. mredelings@dhs.co.la.ca.us
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Redelings
authors.forename: Frank
authors.initials: F
authors.lastname: Sorvillo
authors.forename: Paul
authors.initials: P
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003644:Death Certificates; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control; D011159:Population Surveillance / Q000379:methods; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D012621:Seasons; D014611:Vaccination