title: Socioeconomic and racial disparities of pediatric invasive pneumococcal disease after the introduction of the 7-valent pneumococcal conjugate vaccine.
abstract: BACKGROUND
  Racial differences have been well described for invasive pneumococcal disease (IPD), but little information exists on how race interacts with community socioeconomic factors.
  
  
  METHODS
  The Active Bacterial Core surveillance/Emerging Infections Program performed active surveillance for IPD in the 20-county Metropolitan Atlanta area. All IPD cases among children younger than 5 years from 2001 to 2009 were geocoded and linked to census tract-level socioeconomic measures from the 2000 US Census. Race- and socioeconomic-specific average annual incidence rates per 100,000 population were calculated. Trends in IPD incidence were determined by χ² tests for trend. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression.
  
  
  RESULTS
  IPD incidence among the total population of children increased as percentage of household poverty increased (P = 0.002), as median household income decreased (P < 0.001), as wealth decreased (P = 0.018) and as percentage of individuals with less than a high school education increased (P = 0.023). After stratifying by race, there was no significant linear trend between socioeconomic characteristics and IPD incidence among white children; among black children, however, IPD incidence decreased as socioeconomic conditions worsened. Despite adjusting for sex and socioeconomic factors, the IPD rate remained higher among black children compared with white children (RR = 1.60; 95% CI: 1.39-1.84). Differences in RR of IPD associated with highest poverty and lowest wealth noted in 2001 [RR = 2.71 (95% CI: 2.17-3.39) and 1.80 (95% CI: 1.09-2.96), respectively] declined in 2009 [RR = 1.33 (95% CI: 0.90-1.96) and 0.76 (95% CI: 0.48-1.19), respectively].
  
  
  CONCLUSIONS
  Although socioeconomic disparities in IPD incidence exist among children, the association between socioeconomic characteristics and IPD rates may differ by race and may change over time. Community-level socioeconomic factors did not account for racial differences in IPD incidence.
authors.affiliation: From the *Department of Medicine, Emory University School of Medicine, Atlanta, GA; †Department of Medicine, Atlanta Research and Education Foundation, Decatur, GA; and ‡Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Spicer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thomas
authors.forename: Amy
authors.initials: A
authors.lastname: Holst
authors.forename: Wendy
authors.initials: W
authors.lastname: Baughman
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005845:Georgia / Q000453:epidemiology; D054624:Health Status Disparities; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015233:Models, Statistical; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000208:ethnology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D011159:Population Surveillance; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines