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Article: Jackson LA et al. Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults. 348:1747-55.

Supplementary Appendix 1

Classification of Covariates

According to the criteria for eligibility, all the subjects were enrolled for at least one year before the starting date of the study; however, since 95 percent had been enrolled for at least two years before that date, ICD-9-CM diagnosis codes recorded within the two-year period before the starting date were used to classify relevant study covariates. Prescriptions issued during the year before the starting date were used to fulfill medication-based criteria. Status in the regional tumor registry and in the diabetes and heart disease registries as of the study starting date was used to define relevant covariates.

Coronary artery disease was defined as fulfillment of one or more of the following criteria: a hospital-discharge diagnosis code for coronary artery disease (codes 410 to 413, 414.0, 414.8, 414.9, 427.5, or 429.2); an outpatient diagnosis code of 410.9, 412, 413.9, 414.0, 414.9, 428.0, or 429.2 and at least one prescription for nitrates; a hospital-discharge diagnosis of congestive heart failure or cardiomyopathy (code 402.01, 402.11, 402.91, 425, or 428) or an outpatient code of 428, in addition to at least one prescription for furosemide; or inclusion in the secondary heart disease prevention registry, which tracks patients who have had a previous myocardial infarction, who have been hospitalized for unstable angina, or who have undergone coronary-artery revascularization procedures.

Chronic lung disease was defined as a hospital-discharge diagnosis code of 491, 492, 493.0, 493.1, 493.2, 493.9, or 496 or an outpatient diagnosis code of 492, 493, or 496 and at least one prescription for a corticosteroid, cromolyn, or beta-agonist inhaler or theophylline. Dementia or stroke was defined as a hospital-discharge diagnosis code of 290, 294.1, 331.0, 431, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, or 434.91 or at least two of the following outpatient diagnosis codes: 290, 294.8, 331.0, and 436.

Immunosuppression was defined as the presence of cancer (inclusion in a tumor registry for any cancer except nonmelanoma skin cancer, a hospitalization diagnosis code of 140 to 172 or 174 to 208, or at least two outpatient diagnosis codes of 140 to 172 or 174 to 208), chemotherapy or radiation therapy for cancer, the use of immunosuppressive medications, chronic liver disease (a hospitalization diagnosis code of 570, 571, 572.2, 572.3, 572.4, or 572.8 or at least two outpatient visits with a diagnosis code of 571), or chronic renal disease (a hospitalization diagnosis code of 581 to 583, 585 to 588, or 593.9; at least two outpatient diagnosis codes of 581 to 583, 585 to 588, or 593.9; a code for kidney transplantation [V42.0]; or inclusion on a list of patients undergoing renal dialysis in a Group Health registry).

Diabetes mellitus was defined as inclusion in the diabetes registry, which is based on prescriptions for insulin or oral hypoglycemic agents or consistently abnormal glucose or glycosylated hemoglobin values.


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