Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews is currently utilised (OR 0.48, 95% CI 0.37 to 0.61; random-e ects model, I 2 statistic = 31%). This review did not consider adverse events as it was outside the scope of the review. Authors' conclusions This meta-analysis provides evidence supporting the recommendation for PPV to prevent IPD in adults. The evidence from RCTs is less clear with respect to adults with chronic illness. This might be because of lack of e ect or lack of power in the studies. The meta-analysis does not provide evidence to support the routine use of PPV to prevent all-cause pneumonia or mortality.

BackgroundDiseases caused by Streptococcus pneumoniae (S. pneumoniae) continue to cause substantial morbidity and mortality globally. Whilst pneumococcal polysaccharide vaccines (PPV) have the potential to prevent disease and death, the degree of protection afforded against various clinical endpoints and within different populations is uncertain. ObjectivesTo assess the effectiveness of PPV in preventing disease or death in adults. Adverse events were not assessed. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (

BackgroundDiseases caused by Streptococcus pneumoniae (S. pneumoniae) continue to cause substantial morbidity and mortality throughout the world. Polysaccharide pneumococcal vaccines have been developed for over 50 years and may have the potential to prevent disease and death. ObjectivesTo assess the effectiveness of polysaccharide pneumococcal vaccination in preventing disease or death in adults. Search strategyTrials were identified by electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) issue 2, 2003 (which includes the Cochrane ARI Group's specialised register); MEDLINE (January 1966 to June 2003 and EMBASE (1974 to June 2003). We searched existing literature. The bibliographies of all newly revealed studies were read in order to identify further studies. The vaccine manufacturers, the lead authors of newly identified studies not included in existing meta-analyses were contacted. Selection criteriaA) Prospective, randomised or quasi-randomised studies comparing pneumococcal vaccines with placebo, control vaccines or no intervention. B) Case-control studies (including indirect cohort studies) assessing pneumococcal vaccine effectiveness against invasive pneumococcal disease. Cohort studies are excluded. Data collection and analysis A) Randomised studiesTrial quality assessment was conducted by two reviewers (JH and DT). Data extraction was done by three reviewers (JH, DT, KD). There were many instances of unclear or incomplete data in the trial reports, and the final dataset was arrived at after much deliberation and discussion, including comparison with the data used in two previous reviews of this question. Due to the age of the trials (dating back to 1954 in one case) it was not generally possible to obtain clarification from the authors, though a partial clarification was achieved in one case. B) Non-randomised studiesStudy quality was assessed by two reviewers (RA and KD).

Liver transplantation (LT) is the final step in a complex care cascade. Little is known about how race, gender, rural versus urban residence, or neighborhood socioeconomic indicators impact a patient's likelihood of LT waitlisting or risk of death during LT evaluation. We performed a retrospective cohort study of adults referred for LT to the Indiana University Academic Medical Center from 2011 to 2018. Neighborhood socioeconomic status indicators were obtained by linking patients' addresses to their census tract defined in the 2017 American Community Survey. Descriptive statistics were used to describe completion of steps in the LT evaluation cascade. Multivariable analyses were performed to assess the factors associated with waitlisting and death during LT evaluation. There were 3454 patients referred for LT during the study period; 25.3% of those referred were waitlisted for LT. There was no difference seen in the proportion of patients from vulnerable populations who progressed to the steps of financial approval or evaluation start. There were differences in waitlisting by insurance type (22.6% of Medicaid vs. 34.3% of those who were privately insured; p < 0.01) and neighborhood poverty (quartile 1 29.6% vs. quartile 4 20.4%; p < 0.01). On multivariable analysis, neighborhood poverty was independently associated with waitlisting (odds ratio 0.56, 95% confidence interval [CI] 0.38–0.82) and death during LT evaluation (hazard ratio 1.49, 95% CI 1.09–2.09). Patients from high‐poverty neighborhoods are at risk of failing to be waitlisted and death during LT evaluation.

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