Abstract Background/Aims Adults with rheumatic and musculoskeletal diseases (RMDs), particularly those receiving immunosuppressive therapy, are at increased risk of pneumococcal infection. Despite national recommendations, limited evidence suggests that vaccine uptake in this population is suboptimal. This study aimed to quantify pneumococcal vaccine use for RMDs specifically and to assess pneumonia-related hospitalisation and mortality outcomes in adults with RMDs in the NHS Greater Glasgow and Clyde Health Board area in Scotland, UK. Methods A retrospective cohort study was conducted using linked health data from the West of Scotland Safe Haven. Adults aged 18-64 years who had attended ≥3 rheumatology outpatient appointments between 2010-2025 and were unvaccinated at diagnosis were included. For uptake analysis, patients ≥65 years at time of rheumatology diagnosis were excluded as these patients are eligible for pneumococcal vaccination due to their age. A high-risk subgroup was defined of those with RMDs in receipt of homecare targeted therapies. Vaccine uptake, infection rates and 30-day mortality following all-cause pneumonia hospitalisation were analysed using logistic regression, incidence rate calculations, and Cox proportional hazard models. Results Among 20,707 eligible RMD patients, 33.0% received a pneumococcal vaccine before age 65, rising to 58.4% in the high-risk homecare cohort (N = 3,215). An additional 10.5% in the main cohort and 6.5% in the high-risk cohort were vaccinated after age 65. In the main cohort, compared to those aged 50-64 years, individuals aged 18-34 years had significantly lower odds of receiving a pneumococcal vaccination (OR = 0.78, 95% CI: 0.71-0.85), while those aged 35-49 years were more likely to be vaccinated early (OR = 1.40, 95% CI: 1.31-1.50). Patients from the most deprived quintile were less likely to be vaccinated before age 65. Among the high-risk group, male sex was associated with reduced uptake (OR = 0.79, 95% CI: 0.68-0.92). Hospitalisation rates for all-cause pneumonia increased with age and were consistently higher in the high-risk homecare group. Among those aged ≥65, infection rates were 20.6 per 1,000 person-years in the main cohort and 29.8 in the high-risk cohort. 30-day mortality following all-cause pneumonia hospitalisation rose steeply with age. In the main cohort, mortality was 20.4% in those aged ≥65, compared to 11.6% (50-64 years) and 7.7% (35-49 years). Male sex was associated with increased mortality risk (HR = 1.56, p 0.001). In the high-risk group, age remained a significant predictor of mortality (HR = 1.09/year, p 0.001), but sex was not. Conclusion Pneumococcal vaccination uptake among adults with RMDs remains suboptimal, particularly in younger and socioeconomically deprived populations. Age is associated with increased all-cause pneumonia hospitalisation and mortality, particularly in those receiving targeted therapies, highlighting the need for targeted and strengthened pneumococcal vaccination strategies. These efforts are essential to prevent avoidable all-cause pneumonia-related morbidity and mortality in this vulnerable group. This study was sponsored by Pfizer. Disclosure F. Morton: None. A. Barkaway: Shareholder/stock ownership; Pfizer. Other; Pfizer employee. J. Campling: Shareholder/stock ownership; Pfizer. Other; Pfizer employee. A. Vyse: Shareholder/stock ownership; Pfizer. Other; Pfizer employee. M. McLean: Other; Former Pfizer employee. D. Lowe: Corporate appointments; Director Codebase / ScribePro and board of HI paediatric charity. Consultancies; AstraZeneca, Boehringer Ingelheim, BT Health, MHRA, Novo Nordisk. Shareholder/stock ownership; ScribePro, DK Holdings. Honoraria; (Covered by consultancies) and Qure.ai, AiDoc. Grants/research support; AiDoc, Qure.ai, Annalise.ai, Newton tree, Health Navigator. M. Murphy: Consultancies; Tillotts, Shionogi. Honoraria; (covered by consultancies). Grants/research support; Pfizer, Biomerieux. S. Siebert: Consultancies; Astrazeneca. Honoraria; (covered by consultancies). Member of speakers’ bureau; Pfizer. Grants/research support; Pfizer.
Morton et al. (Wed,) studied this question.