{
  "abstract": "Objectives: To evaluate the real-world effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in reducing all-cause, pneumonia-related, and chronic obstructive pulmonary disease (COPD)-related mortality in adults aged ≥60 years. Methods: In this retrospective cohort study using existing health surveillance data, individuals aged ≥60 years on 1 January 2020 were followed until 31 August 2025 and classified by PPSV23 vaccination status. Propensity score matching (PSM) at a 1:1 ratio balanced sex, age, regional distribution, urbanization level and influenza vaccination status. Time-dependent Cox proportional hazards models estimated hazard ratios (HR) and vaccine effectiveness (VE), defined as (1 - HR) × 100%. Subgroup, negative control (mortality from traffic accidents), and E-value sensitivity analyses were performed. Results: After PSM, 453,500 individuals were included, with a mean follow-up of 5.61 years. All-cause mortality was 3.93 per 1000 person-years in vaccinated versus 9.57 in unvaccinated individuals. PPSV23 vaccination reduced all-cause mortality (VE = 43.1%, 95% CI: 41.2-45.0%), pneumonia-related mortality (VE = 46.2%, 95% CI: 39.6-52.1%), and COPD-related mortality (VE = 33.5%, 95% CI: 20.9-44.2%) (all p < 0.001). In a cause-specific decomposition, pneumonia- and COPD-related deaths together explained only 14.9% of the absolute reduction in all-cause deaths, whereas circulatory diseases and malignant tumors accounted for 36.8% and 31.9%, respectively. Among those also vaccinated against influenza, VE was 48.0% and 38.2% for pneumonia- and COPD-related mortality, respectively. For COPD-related mortality, the benefit was greater in men (VE = 42.3%) and in those aged ≥70 years (70-79 years, VE = 45.6%; ≥80 years, VE = 52.0%). PPSV23 was not associated with the negative control outcome (p = 0.247); E-values (1.98-2.44) indicated robustness to unmeasured confounding. Conclusions: PPSV23 vaccination was associated with significantly lower all-cause, pneumonia-related, and COPD-related mortality among elderly individuals aged ≥60 years. However, the observed association with all-cause mortality should be interpreted cautiously. Continued promotion of PPSV23 vaccination and advocacy for combined influenza-pneumococcal vaccination strategies are recommended.",
  "abstract_shown": true,
  "affiliations": [
    "Guangzhou Center for Disease Control and Prevention (Guangzhou Health Supervision Institute), Guangzhou 510440, China.",
    "Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention (Guangzhou Health Supervision Institute), Guangzhou 510440, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Yan Kang",
      "orcid": "0009-0004-3562-6588"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Zhiwei Zheng"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Juan Qi"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lin Tang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wen Wang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinqi Lin"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Qiaojuan Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wenji Wang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Chunhuan Zhang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jianxiong Xu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Weijia Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Zhoubin Zhang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Boheng Liang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yong Huang",
      "orcid": "0000-0001-7973-4039"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1pnmhwf7gxxqp.bib",
  "cited_by": 0,
  "doi": "10.3390/vaccines14100877",
  "fulltext_url": "https://europepmc.org/articles/PMC13709534",
  "id": "1pnmhwf7gxxqp",
  "issns": [
    "2076-393X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42931406",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Pneumonia and Respiratory Infections"
    ]
  ],
  "openalex": "W7216586026",
  "pdf_url": "https://europepmc.org/articles/PMC13709534?pdf=render",
  "pmcid": "PMC13709534",
  "pmid": "42931406",
  "published": "2026-10-02",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1pnmhwf7gxxqp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:01Z",
      "native_id": "MED:42931406",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42931406"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Pneumonia and Respiratory Infections",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Reducing Mortality Among Older Adults: A Real-World Retrospective Cohort Study in Guangzhou, China.",
  "title_text": "Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Reducing Mortality Among Older Adults: A Real-World Retrospective Cohort Study in Guangzhou, China.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:01Z",
  "url": "https://research.draconitic.com/paper/1pnmhwf7gxxqp",
  "venue": "Vaccines",
  "versions": []
}