Adult Community-Acquired Pneumonia in the United States: The Economic Burden and the Potential Gains From Higher Vaccination Coverage
- 1Conquest Advisors, LLC
Abstract
BackgroundCommunity acquired pneumonia (CAP) imposes a substantial health and economic burden in the United States, but current cost estimates vary widely by population and care setting.
ObjectivesTo estimate annual direct healthcare costs associated with CAP among U.S. adults and evaluate pneumococcal vaccination mortality associations and alternative vaccination uptake scenarios among adults aged 65 years and older.
MethodsUsing outpatient treated pneumonia as a proxy for CAP, event-level expenditures from the 2023 Medical Expenditure Panel Survey were combined with published utilization estimates adjusted to 2023. We estimated annual costs for adults aged 18 and older across six service categories and expressed them in 2025 dollars. We used regression analysis to evaluate associations between changes in self-reported cumulative pneumococcal vaccination uptake and pneumonia mortality across 50 states and Washington, D.C., during 2021 2024. Two scenarios modeled mortality under maintenance of 2017 peak uptake and continuation of the preceding upward trend.
ResultsEstimated annual direct healthcare costs totaled $30.80 billion, including $26.74 billion for inpatient care, approximately 87% of total expenditures. A conservative scenario excluding repeat hospitalizations yielded $28.65 billion. The one year lagged change in vaccination uptake was inversely associated with pneumonia mortality (minus 0.45 deaths per 100,000 per percentage-point increase; p=0.0114). Compared with observed uptake, maintaining the 2017 peak of 74.7% yielded an estimated 1,462 fewer pneumonia deaths among adults aged 65 years and older during 2018 2024. Continuing the earlier annual increase of 0.84 percentage points yielded an estimated 2,855 fewer deaths over the same period.
ConclusionAdult CAP imposes substantial direct healthcare costs, driven primarily by hospitalizations. The observed vaccination mortality association and illustrative mortality projections support renewed efforts to increase pneumococcal vaccination uptake among older adults and monitor its population-level impact.
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BibTeX
@misc{popovian2026adult,
title = {{Adult Community-Acquired Pneumonia in the United States: The Economic Burden and the Potential Gains From Higher Vaccination Coverage}},
author = {R. Popovian and W. Winegarden},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.20.26366031},
url = {https://www.medrxiv.org/content/10.64898/2026.10.20.26366031v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Adult Community-Acquired Pneumonia in the United States: The Economic Burden and the Potential Gains From Higher Vaccination Coverage
AU - R. Popovian
AU - W. Winegarden
PY - 2026
DA - 2026/10/20
PB - medRxiv
DO - 10.64898/2026.10.20.26366031
UR - https://www.medrxiv.org/content/10.64898/2026.10.20.26366031v1
AB - BackgroundCommunity acquired pneumonia (CAP) imposes a substantial health and economic burden in the United States, but current cost estimates vary widely by population and care setting. ObjectivesTo estimate annual direct healthcare costs associated with CAP among U.S. adults and evaluate pneumococcal vaccination mortality associations and alternative vaccination uptake scenarios among adults aged 65 years and older. MethodsUsing outpatient treated pneumonia as a proxy for CAP, event-level expenditures from the 2023 Medical Expenditure Panel Survey were combined with published utilization estimates adjusted to 2023. We estimated annual costs for adults aged 18 and older across six service categories and expressed them in 2025 dollars. We used regression analysis to evaluate associations between changes in self-reported cumulative pneumococcal vaccination uptake and pneumonia mortality across 50 states and Washington, D.C., during 2021 2024. Two scenarios modeled mortality under maintenance of 2017 peak uptake and continuation of the preceding upward trend. ResultsEstimated annual direct healthcare costs totaled $30.80 billion, including $26.74 billion for inpatient care, approximately 87% of total expenditures. A conservative scenario excluding repeat hospitalizations yielded $28.65 billion. The one year lagged change in vaccination uptake was inversely associated with pneumonia mortality (minus 0.45 deaths per 100,000 per percentage-point increase; p=0.0114). Compared with observed uptake, maintaining the 2017 peak of 74.7% yielded an estimated 1,462 fewer pneumonia deaths among adults aged 65 years and older during 2018 2024. Continuing the earlier annual increase of 0.84 percentage points yielded an estimated 2,855 fewer deaths over the same period. ConclusionAdult CAP imposes substantial direct healthcare costs, driven primarily by hospitalizations. The observed vaccination mortality association and illustrative mortality projections support renewed efforts to increase pneumococcal vaccination uptake among older adults and monitor its population-level impact.
ER -