Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Reducing Mortality Among Older Adults: A Real-World Retrospective Cohort Study in Guangzhou, China.

@article{kang2026effectiveness,
  title = {{Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Reducing Mortality Among Older Adults: A Real-World Retrospective Cohort Study in Guangzhou, China.}},
  author = {Yan Kang and Zhiwei Zheng and Juan Qi and Lin Tang and Wen Wang and Xinqi Lin and Qiaojuan Liu and Wenji Wang and Chunhuan Zhang and Jianxiong Xu and Weijia Liu and Zhoubin Zhang and Boheng Liang and Yong Huang},
  journal = {Vaccines},
  year = {2026},
  month = oct,
  doi = {10.3390/vaccines14100877},
  url = {https://europepmc.org/article/MED/42931406},
  note = {CC BY},
}

TY  - JOUR
TI  - Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Reducing Mortality Among Older Adults: A Real-World Retrospective Cohort Study in Guangzhou, China.
AU  - Yan Kang
AU  - Zhiwei Zheng
AU  - Juan Qi
AU  - Lin Tang
AU  - Wen Wang
AU  - Xinqi Lin
AU  - Qiaojuan Liu
AU  - Wenji Wang
AU  - Chunhuan Zhang
AU  - Jianxiong Xu
AU  - Weijia Liu
AU  - Zhoubin Zhang
AU  - Boheng Liang
AU  - Yong Huang
PY  - 2026
DA  - 2026/10/02
JO  - Vaccines
DO  - 10.3390/vaccines14100877
UR  - https://europepmc.org/article/MED/42931406
AB  - 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.
SN  - 2076-393X
ER  -