---
title: "Pneumococcal vaccination uptake and missed opportunities in adults with diabetes: population cohor"
id: "pubmed-42612465"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42612465"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42612465/"
doi: "10.1016/j.vaccine.2026.129063"
published_at: "2026-10-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pneumococcal vaccination uptake and missed opportunities in adults with diabetes: population cohor
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42612465
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42612465/)
- **DOI:** [10.1016/j.vaccine.2026.129063](https://doi.org/10.1016%2Fj.vaccine.2026.129063)
- **Published At:** 2026-10-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This population-based retrospective cohort study evaluated temporal patterns and factors linked to first recorded **pneumococcal vaccination** among adults with **diabetes** in the Romagna Local Health Authority, Italy, using linked administrative healthcare databases. - The cohort included 77,138 individuals (57,113 prevalent diabetes cases and 20,025 incident cases) followed through June 30, 2024. - Monthly coverage rose from 7.2% in January 2017 to 28.0% in June 2024 but remained under 30% overall. - The largest monthly increases in vaccination coverage coincided with **influenza vaccination seasons**, suggesting potential co-administration or opportunistic delivery during influenza campaigns. - In the incident diabetes cohort, cumulative probability of first pneumococcal vaccination was estimated at 4.4% at one year, 12.6% at three years, and 34.8% at seven years, with no pronounced immediate uptake following cohort entry. - Time-to-event analyses used Kaplan–Meier survival estimates, Cox proportional hazards models, and competing-risks methods; death was included as a competing event in specific analyses. - **Age** had the strongest positive association with uptake, with the highest vaccination rates in the 60–69 year age group. - **Foreign citizenship** was associated with substantially lower vaccination uptake. Associations for sex and comorbidity were smaller; comorbidity effects were reduced or reversed when death was modeled as a competing event. - The abstract truncates before presenting broader contextual interpretation or detailed recommendations; additional study details, full results, and contextual discussion were not reported in the provided source excerpt.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 18. # Temporal patterns and potential missed opportunities in pneumococcal vaccination among adults with diabetes: A population-based cohort study [Jacopo Lenzi](https://pubmed.ncbi.nlm.nih.gov/?term=Lenzi+J&cauthor_id=42612465)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-1 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. Electronic address: jacopo.lenzi2@unibo.it."), [Marco Montalti](https://pubmed.ncbi.nlm.nih.gov/?term=Montalti+M&cauthor_id=42612465)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-2 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Rubicone and Cesena-Valle del Savio Health Districts, Romagna Local Health Authority, Via San Lorenzino 23, 47521 Cesena, FC, Italy."), [Zeno Di Valerio](https://pubmed.ncbi.nlm.nih.gov/?term=Di+Valerio+Z&cauthor_id=42612465)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-3 "Department of Epidemiology of the Lazio Regional Health Service, Local Health Authority "Roma 1", Via Cristoforo Colombo 112, 00147, Rome, RM, Italy."), [Valeria Frassineti](https://pubmed.ncbi.nlm.nih.gov/?term=Frassineti+V&cauthor_id=42612465)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-4 "Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Paolo Benetti](https://pubmed.ncbi.nlm.nih.gov/?term=Benetti+P&cauthor_id=42612465)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-5 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy; Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Rossella Messina](https://pubmed.ncbi.nlm.nih.gov/?term=Messina+R&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Simona Rosa](https://pubmed.ncbi.nlm.nih.gov/?term=Rosa+S&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Andrea Casadei](https://pubmed.ncbi.nlm.nih.gov/?term=Casadei+A&cauthor_id=42612465)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-7 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy."), [Maria Pia Fantini](https://pubmed.ncbi.nlm.nih.gov/?term=Fantini+MP&cauthor_id=42612465)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-8 "Alma Mater Professor, University of Bologna, Via Luigi Zamboni 33, 40126 Bologna, BO, Italy."), [Paolo Di Bartolo](https://pubmed.ncbi.nlm.nih.gov/?term=Di+Bartolo+P&cauthor_id=42612465)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-9 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Diabetology Unit, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Davide Gori](https://pubmed.ncbi.nlm.nih.gov/?term=Gori+D&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Giulia Silvestrini](https://pubmed.ncbi.nlm.nih.gov/?term=Silvestrini+G&cauthor_id=42612465)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#full-view-affiliation-4 "Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy.") Affiliations Expand ### Affiliations * 1 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. Electronic address: jacopo.lenzi2@unibo.it. * 2 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Rubicone and Cesena-Valle del Savio Health Districts, Romagna Local Health Authority, Via San Lorenzino 23, 47521 Cesena, FC, Italy. * 3 Department of Epidemiology of the Lazio Regional Health Service, Local Health Authority "Roma 1", Via Cristoforo Colombo 112, 00147, Rome, RM, Italy. * 4 Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * 5 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy; Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * 6 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. * 7 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy. * 8 Alma Mater Professor, University of Bologna, Via Luigi Zamboni 33, 40126 Bologna, BO, Italy. * 9 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Diabetology Unit, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * PMID: **42612465** * DOI: [ 10.1016/j.vaccine.2026.129063 ](https://doi.org/10.1016/j.vaccine.2026.129063) Free article Item in Clipboard # Temporal patterns and potential missed opportunities in pneumococcal vaccination among adults with diabetes: A population-based cohort study Jacopo Lenzi et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42612465/) . 2026 Oct 3:91:129063. doi: 10.1016/j.vaccine.2026.129063. Epub 2026 Aug 18. ### Authors [Jacopo Lenzi](https://pubmed.ncbi.nlm.nih.gov/?term=Lenzi+J&cauthor_id=42612465)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-1 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. Electronic address: jacopo.lenzi2@unibo.it."), [Marco Montalti](https://pubmed.ncbi.nlm.nih.gov/?term=Montalti+M&cauthor_id=42612465)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-2 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Rubicone and Cesena-Valle del Savio Health Districts, Romagna Local Health Authority, Via San Lorenzino 23, 47521 Cesena, FC, Italy."), [Zeno Di Valerio](https://pubmed.ncbi.nlm.nih.gov/?term=Di+Valerio+Z&cauthor_id=42612465)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-3 "Department of Epidemiology of the Lazio Regional Health Service, Local Health Authority "Roma 1", Via Cristoforo Colombo 112, 00147, Rome, RM, Italy."), [Valeria Frassineti](https://pubmed.ncbi.nlm.nih.gov/?term=Frassineti+V&cauthor_id=42612465)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-4 "Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Paolo Benetti](https://pubmed.ncbi.nlm.nih.gov/?term=Benetti+P&cauthor_id=42612465)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-5 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy; Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Rossella Messina](https://pubmed.ncbi.nlm.nih.gov/?term=Messina+R&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Simona Rosa](https://pubmed.ncbi.nlm.nih.gov/?term=Rosa+S&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Andrea Casadei](https://pubmed.ncbi.nlm.nih.gov/?term=Casadei+A&cauthor_id=42612465)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-7 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy."), [Maria Pia Fantini](https://pubmed.ncbi.nlm.nih.gov/?term=Fantini+MP&cauthor_id=42612465)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-8 "Alma Mater Professor, University of Bologna, Via Luigi Zamboni 33, 40126 Bologna, BO, Italy."), [Paolo Di Bartolo](https://pubmed.ncbi.nlm.nih.gov/?term=Di+Bartolo+P&cauthor_id=42612465)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-9 "Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Diabetology Unit, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy."), [Davide Gori](https://pubmed.ncbi.nlm.nih.gov/?term=Gori+D&cauthor_id=42612465)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-6 "Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy."), [Giulia Silvestrini](https://pubmed.ncbi.nlm.nih.gov/?term=Silvestrini+G&cauthor_id=42612465)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42612465/#short-view-affiliation-4 "Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy.") ### Affiliations * 1 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. Electronic address: jacopo.lenzi2@unibo.it. * 2 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Rubicone and Cesena-Valle del Savio Health Districts, Romagna Local Health Authority, Via San Lorenzino 23, 47521 Cesena, FC, Italy. * 3 Department of Epidemiology of the Lazio Regional Health Service, Local Health Authority "Roma 1", Via Cristoforo Colombo 112, 00147, Rome, RM, Italy. * 4 Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * 5 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy; Department of Public Health, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * 6 Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126 Bologna, BO, Italy. * 7 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy. * 8 Alma Mater Professor, University of Bologna, Via Luigi Zamboni 33, 40126 Bologna, BO, Italy. * 9 Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, BO, Italy; Diabetology Unit, Romagna Local Health Authority, Via Fiume Montone Abbandonato 134, 48121 Ravenna, RA, Italy. * PMID: **42612465** * DOI: [ 10.1016/j.vaccine.2026.129063 ](https://doi.org/10.1016/j.vaccine.2026.129063) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Pneumococcal vaccination is recommended for adults with diabetes because of their increased risk of pneumococcal disease, yet uptake remains suboptimal. This population-based retrospective cohort study assessed temporal patterns and factors associated with first recorded pneumococcal vaccination among adults with diabetes in the Romagna Local Health Authority, Italy, using linked administrative healthcare databases. We included 77,138 individuals (57,113 prevalent and 20,025 incident cases) followed through June 30, 2024. Monthly coverage was estimated using a person-time approach; time to vaccination and associated factors were examined using Kaplan-Meier, Cox, and competing-risks methods. Coverage increased from 7.2% in January 2017 to 28.0% in June 2024 but remained below 30%, with the largest monthly gains occurring during influenza vaccination seasons. In the incident cohort, the estimated cumulative probability of vaccination was 4.4% at one year, 12.6% at three years, and 34.8% at seven years, without a marked early increase after cohort entry. Age showed the strongest association with uptake, peaking at 60-69 years. Foreign citizenship was associated with markedly lower uptake, while associations with sex and comorbidity were more modest; comorbidity-related estimates were attenuated or reversed when death was treated as a competing event. Contextu
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