BACKGROUND: The pneumococcal polysaccharide vaccine prevents pneumococcal disease and is recommended for adults ≥65 years old. The Centers for Disease Control and Prevention (CDC) recommends the vaccine for adults aged 19-64 years who smoke cigarettes, as well as for all adults ≥65 years old. A cross-sectional study was conducted using the Tennessee Behavioral Risk Factor Surveillance System (BRFSS) to understand the relationship between cigarette smoking and pneumococcal vaccine coverage among adult Tennesseans.
METHODS: The Tennessee BRFSS was utilized for data years 2014 and 2015 to understand the relationship between cigarette smokers and pneumococcal vaccine coverage. Age was dichotomized as adults aged 19 to 64 years versus ≥65 years. Backwards elimination logistic regression was performed to assess the relationship between current cigarette smokers (exposure) and pneumococcal vaccine coverage (outcome). Covariates considered as potential confounders were sex, age within the two age groups (as a continuous variable), health insurance status, race, myocardial infarction, angina, stroke, asthma, cancers, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, diabetes, and heavy drinking.
RESULTS: Of the 10,929 Tennessee BRFSS respondents who fit the inclusion criteria for data years 2014 and 2015, 4,262 (39%) were aged 19-64 years, and 6,667 (61%) were 65 years or older. A higher proportion of respondents ≥65 years old had the pneumococcal vaccine (72.8%), versus those aged 19-64 years (24.2%). COPD was a significant confounder for both age groups and used in the final model. When fit with a logistic regression, the crude odds ratio (OR) for current smokers having had the pneumococcal vaccine was 1.28 (95% CI: 1.05, 1.56) for respondents aged 19-64 years, and 0.60 (95% CI: 0.45, 0.80) for respondents ≥65 years old. While controlling for COPD status, the OR for having had the pneumococcal vaccine among smokers in the 19-64 year old age group was 1.00 (0.80, 1.25), and 0.46 (0.34, 0.62) in the ≥65 years old group.
CONCLUSIONS: Adult “current smoker” Tennesseans who were 19-64 years old were not statistically more likely to have received the pneumococcal vaccine versus respondents who self-reported as “not a current smoker,” even though these individuals have a higher risk of pneumococcal infection. Adult smokers ≥65 years old were statistically less likely to have received the pneumococcal vaccine versus non-smokers. A strong public health message describing the benefits of pneumococcal vaccination for all adult current smokers in Tennessee, regardless of the CDC’s age suggestion may help prevent pneumococcal diseases in this population.