OBJECTIVES: The purpose of this study was to characterize U.S. national trends of the incidence of pneumococcal meningitis (PM), with an interest in differences prior- and post-licensure of the 13-valent pneumococcal conjugate vaccine (PCV13). The objectives were 1) to describe the incidence and related outcomes of PM patients and 2) to evaluate risk factors for PM among adults with selected chronic medical conditions. METHODS:  This was a retrospective analysis of the National Inpatient Sample from 2008 to 2013. Patients were identified with the International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis code for PM (320.1). Three periods were observed: 2008-2009 (pre-PCV13), 2010 (transition year), and 2011-2013 (post-PCV13). Data were weighted to generate national estimates and hospitalizations were reported per 100,000 discharges. In-hospital mortality and length of stay (LOS) were presented descriptively and a multivariable logistic model was utilized to identify risk factors associated with PM. RESULTS:  During 2008-2013, there were 9283 hospitalizations due to PM in the U.S. Incidence of PM remained steady up to the introduction of PCV13 following which PM incidence increased from 3.96 hospitalizations/100,000 in 2011 to 4.14/100,000 in 2013. From 2011-2013, similar increases were seen for median LOS (8.64 days to 9.3 days) and in-hospital mortality (9.55% to 11.19%). In children aged <2 years the rate of PM hospitalizations increased from 2011-2013 (0.18/100,000 to 0.22/100,000) with a similar increase among children aged 2 to 4 years (0.06/100,000 to 0.18/100,000). Significant risk factors for PM in adults aged 19-64 years included alcoholism (aOR=2.89; 95% CI: 2.16, 3.86), diabetes (aOR=1.80; 95% Cl: 1.44, 2.25), and chronic heart failure (aOR=2.44; 95% CI: 1.64, 3.63). CONCLUSIONS: Following the introduction of PCV13, incidence of PM increased in the U.S. with a similar trend in patient mortality and hospital LOS. Selected chronic medical conditions in which PCV13 is not indicated are risk factors for PM.