Background Information concerning sex differences in pneumococcal vaccine effectiveness in adults is scarce. The main aim of this study is to compare the differences in clinical effectiveness of pneumococcal vaccination between male and female adults. Methods Population-based cohort study involving 1,108,634 women and 951,011 men aged ≥50years in Catalonia, Spain. Baseline characteristics of cohort members (comorbidities/underlying conditions and PPsV23/PCV13 vaccination status) were established according to Institutional Research Database (SIDIAP) and pneumococcal disease-related hospitalizations (PDRH) captured from hospital discharge codes from 68 reference Catalonian hospitals, throughout 01/01/2017-31/12/2018. Cox regression models were used to estimate PPsV23/PCV13 effectiveness against PDRH by sex (adjusting for age and comorbidities/underlying risk conditions). Results Across the two-year follow-up 4,302 PDRH cases (1,878 women, 2,424 men) were observed, with incidences of 169.4/100,000 and 254.9/100,000 for women and men, respectively. Among women, nor PPsV23 ((hazard ratio [HR]:1.04; 95% CI:0.92- 1.18; p=0.540) neither PCV13 (HR:1.24; 95% CI:0.91-1.70; p=0.171)) altered PDRH risk. Among men, PCV13 was associated with significantly increased risk of PDRH (HR: 1.57; 95% CI: 1.07-2.31; p=0.021) whereas PPsV23 did not significantly alter this risk (HR:0.89; 95% CI:0.72-1.10; p=0.275). No reduced risk of death from PDRH was observed in vaccinated women or men. However, regarding all-cause death, PPsV23 showed slight reduction risk for women (HR:0.94; 95% CI:0.92-0.97; p<0.001). Conclusions PPsV23/PCV13 vaccinations have not proven effective for either sex in preventing PDRH. PPsV23 appears associated with slight reduction risk of all-cause death in women, which could be related to better or longer-lasting vaccination effects in women compared to men.

中文翻译：

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评估成人肺炎球菌疾病负担和疫苗接种效果的性别差异：一项基于人群的研究


关于成人肺炎球菌疫苗有效性性别差异的背景信息很少。本研究的主要目的是比较男性和女性成人肺炎球菌疫苗接种临床效果的差异。方法 基于人群的队列研究，涉及西班牙加泰罗尼亚的 1,108,634 名女性和 951,011 名 ≥50 岁的男性。队列成员的基线特征（合并症/潜在疾病和 PPsV23/PCV13 疫苗接种状态）是根据机构研究数据库 （SIDIAP） 和肺炎球菌疾病相关住院 （PDRH） 建立的，从 68 家参考加泰罗尼亚医院的出院代码中捕获，整个 2017 年 1 月 1 日至 2018 年 12 月 31 日。使用 Cox 回归模型按性别估计 PPsV23/PCV13 对 PDRH 的有效性 （根据年龄和合并症/潜在风险条件进行调整）。结果 在两年的随访中，共观察到 4,302 例 PDRH 病例 （1,878 例女性，2,424 例男性），女性和男性的发病率分别为 169.4/100,000 例和 254.9/100,000 例。在女性中，PPsV23 （（风险比 [HR]：1.04;95% CI：0.92- 1.18;p=0.540） PCV13 （HR：1.24;95% CI：0.91-1.70;p=0.171）） 均未改变 PDRH 风险。在男性中，PCV13 与 PDRH 风险显著增加相关 （HR： 1.57;95% CI： 1.07-2.31;p=0.021），而 PPsV23 没有显著改变这种风险 （HR：0.89;95% CI：0.72-1.10;p=0.275）。在接种疫苗的女性或男性中未观察到 PDRH 死亡风险降低。然而，关于全因死亡，PPsV23 显示女性风险略有降低 （HR：0.94;95% CI：0.92-0.97;p<0.001）。结论 PPsV23/PCV13 疫苗接种未证明对任何性别都有效预防 PDRH。 PPsV23 似乎与女性全因死亡风险略有降低有关，这可能与女性与男性相比更好或更持久的疫苗接种效果有关。