OBJECTIVES: To estimate invasive meningococcal disease (IMD) prevalence and describe the clinical risk factors associated with IMD in the United States (US).

METHODS: We conducted a retrospective matched case-control study using a large US database covering part of the population with commercial and Medicare health plans from 01/01/2010 to 03/31/2022. Index date was defined as the earliest emergency department visit or hospitalization with an IMD diagnosis code (preceded by ≥12 months of continuous enrollment without a claim for IMD or invasive pneumococcal disease). IMD cases were matched to ≤5 controls based on birth year, sex, and state of residence. Conditional logistic regression analysis was used to obtain adjusted odds ratios (aOR) for IMD risk.

RESULTS: We identified 17,935 patients with any IMD diagnosis (of 63,774,385) and selected 616 eligible cases and 3,058 matched controls. The mean age was 60.2 years (standard deviation: 21.7; >80% were ≥36 years old) and the IMD prevalence proportion was 0.001% (616/63,774,385). Higher healthcare utilization was significantly associated with IMD: pediatrician/primary care visits (aOR: 1.02; 95%CI: 1.00–1.04), other physician visits (aOR: 1.02; 95% CI: 1.01–1.03), and hospitalizations (aOR: 3.13; 95% CI: 2.70–3.62). Although estimated with less precision due to low patient counts, HIV was also associated with IMD (aOR: 3.36; 95% CI: 0.92–12.26). Other known IMD risk factors, such as complement component deficiency, asplenia, and eculizumab medication, were not associated with IMD due to their extremely low counts.

CONCLUSIONS: IMD is a rare, unpredictable, and catastrophic disease. Our study shows significant positive associations between healthcare utilization (likely as marker of poor-health) and HIV with IMD risk. Healthcare interventions such as vaccination could minimize IMD risk. Future research in Medicaid- and non-insured individuals could identify IMD and associated risk factors among younger and underserved populations.