- Link-Gelles, Ruth;
- Westreich, Daniel;
- Aiello, Allison E;
- Shang, Nong;
- Weber, David J;
- Holtzman, Corinne;
- Scherzinger, Karen;
- Reingold, Arthur;
- Schaffner, William;
- Harrison, Lee H;
- Rosen, Jennifer B;
- Petit, Susan;
- Farley, Monica;
- Thomas, Ann;
- Eason, Jeffrey;
- Wigen, Christine;
- Barnes, Meghan;
- Thomas, Ola;
- Zansky, Shelley;
- Beall, Bernard;
- Whitney, Cynthia G;
- Moore, Matthew R
In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the US for prevention of invasive pneumococcal disease in children. Individual-level socioeconomic status (SES) is a potential confounder of the estimated effectiveness of PCV13 and is often controlled for in observational studies using zip code as a proxy. We assessed the utility of zip code matching for control of SES in a post-licensure evaluation of the effectiveness of PCV13 (calculated as [1-matched odds ratio]*100). We used a directed acyclic graph to identify subsets of confounders and collected SES variables from birth certificates, geo-coding, a parent interview, and follow-up with medical providers. Cases tended to be more affluent than eligible controls (for example, 48.3% of cases had private insurance vs. 44.6% of eligible controls), but less affluent than enrolled controls (52.9% of whom had private insurance). Control of confounding subsets, however, did not result in a meaningful change in estimated vaccine effectiveness (original estimate: 85.1%, 95% CI 74.8-91.9%; adjusted estimate: 82.5%, 95% CI 65.6-91.1%). In the context of a post-licensure vaccine effectiveness study, zip code appears to be an adequate, though not perfect, proxy for individual SES.