Incidence and risk factors of pneumococcal pneumonia in adults: a population-based study.
Adults
Incidence
Multimorbidity
Pneumococcal pneumonia
Risk factors
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
08 Jun 2023
08 Jun 2023
Historique:
received:
22
03
2023
accepted:
26
05
2023
medline:
12
6
2023
pubmed:
9
6
2023
entrez:
8
6
2023
Statut:
epublish
Résumé
Infection caused by Streptococcus pneumoniae, mainly invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP), are a major public health problem worldwide. This study investigated population-based incidence and risk of PP among Catalonian persons ≥ 50 years-old with and without specific underlying conditions/comorbidities, examining the influence of single and multi-comorbidities in the risk of suffering PP. Population-based cohort study involving 2,059,645 persons ≥ 50 years-old in Catalonia, Spain, who were retrospectively followed between 01/01/2017-31/12/2018. The Catalonian information system for development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities/underlying conditions), and PP cases were collected from discharge codes (ICD-10: J13) of the 68 referral Catalonian hospitals. Global incidence rate (IR) was 90.7 PP cases per 100,000 person-years, with a 7.6% (272/3592) case-fatality rate (CFR). Maximum IRs emerged among persons with history of previous IPD or all-cause pneumonia, followed by haematological neoplasia (475.0), HIV-infection (423.7), renal disease (384.9), chronic respiratory disease (314.7), liver disease (232.5), heart disease (221.4), alcoholism (204.8), solid cancer (186.2) and diabetes (159.6). IRs were 42.1, 89.9, 201.1, 350.9, 594.3 and 761.2 in persons with 0, 1, 2, 3, 4 and ≥ 5 comorbidities, respectively. In multivariable analyses, HIV-infection (hazard ratio [HR]: 5.16; 95% CI: 3.57-7.46), prior all-cause pneumonia (HR: 3.96; 95% CI: 3.45-4.55), haematological neoplasia (HR: 2.71; 95% CI: 2.06-3.57), chronic respiratory disease (HR: 2.66; 95% CI: 2.47-2.86) and prior IPD (HR: 2.56; 95% CI: 2.03-3.24) were major predictors for PP. Apart of increasing age and immunocompromising conditions (classically recognised as high-risk conditions), history of prior IPD/pneumonia, presence of chronic pulmonary/respiratory disease and/or co-existing multi-comorbidity (i.e., two or more underlying conditions) are major risk factors for PP in adults, with an excess risk near to immunocompromised subjects. Redefining risk categories for PP, including all the above-mentioned conditions into the high-risk category, could be necessary to improve prevention strategies in middle-aged and older adults.
Sections du résumé
BACKGROUND
BACKGROUND
Infection caused by Streptococcus pneumoniae, mainly invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP), are a major public health problem worldwide. This study investigated population-based incidence and risk of PP among Catalonian persons ≥ 50 years-old with and without specific underlying conditions/comorbidities, examining the influence of single and multi-comorbidities in the risk of suffering PP.
METHODS
METHODS
Population-based cohort study involving 2,059,645 persons ≥ 50 years-old in Catalonia, Spain, who were retrospectively followed between 01/01/2017-31/12/2018. The Catalonian information system for development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities/underlying conditions), and PP cases were collected from discharge codes (ICD-10: J13) of the 68 referral Catalonian hospitals.
RESULTS
RESULTS
Global incidence rate (IR) was 90.7 PP cases per 100,000 person-years, with a 7.6% (272/3592) case-fatality rate (CFR). Maximum IRs emerged among persons with history of previous IPD or all-cause pneumonia, followed by haematological neoplasia (475.0), HIV-infection (423.7), renal disease (384.9), chronic respiratory disease (314.7), liver disease (232.5), heart disease (221.4), alcoholism (204.8), solid cancer (186.2) and diabetes (159.6). IRs were 42.1, 89.9, 201.1, 350.9, 594.3 and 761.2 in persons with 0, 1, 2, 3, 4 and ≥ 5 comorbidities, respectively. In multivariable analyses, HIV-infection (hazard ratio [HR]: 5.16; 95% CI: 3.57-7.46), prior all-cause pneumonia (HR: 3.96; 95% CI: 3.45-4.55), haematological neoplasia (HR: 2.71; 95% CI: 2.06-3.57), chronic respiratory disease (HR: 2.66; 95% CI: 2.47-2.86) and prior IPD (HR: 2.56; 95% CI: 2.03-3.24) were major predictors for PP.
CONCLUSION
CONCLUSIONS
Apart of increasing age and immunocompromising conditions (classically recognised as high-risk conditions), history of prior IPD/pneumonia, presence of chronic pulmonary/respiratory disease and/or co-existing multi-comorbidity (i.e., two or more underlying conditions) are major risk factors for PP in adults, with an excess risk near to immunocompromised subjects. Redefining risk categories for PP, including all the above-mentioned conditions into the high-risk category, could be necessary to improve prevention strategies in middle-aged and older adults.
Identifiants
pubmed: 37291502
doi: 10.1186/s12890-023-02497-2
pii: 10.1186/s12890-023-02497-2
pmc: PMC10251659
doi:
Substances chimiques
Pneumococcal Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
200Subventions
Organisme : This work was supported by a grant from the "Fondo de Investigación Sanitaria" of the "Instituto de Salud Carlos III" (call 2020) for the "Acción Estratégica en Salud 2020/2030 (code file PI20/01223), cofinanced by the European Union through the "Fondo Europeo de Desarrollo Regional" (FEDER).
ID : code file PI20/01223
Informations de copyright
© 2023. The Author(s).
Références
Clin Infect Dis. 2021 Oct 5;73(7):e1489-e1497
pubmed: 32716500
Vaccine. 2019 Jan 7;37(2):226-234
pubmed: 30527660
Expert Rev Vaccines. 2021 Mar;20(3):243-256
pubmed: 33478306
Pharmacoeconomics. 2019 Sep;37(9):1093-1127
pubmed: 31025189
Vaccine X. 2023 Jan 21;13:100264
pubmed: 36798107
Respir Med. 2018 Apr;137:6-13
pubmed: 29605214
Clin Infect Dis. 2017 Oct 30;65(10):1736-1744
pubmed: 29028977
Lung. 2020 Jun;198(3):481-489
pubmed: 32253492
BMC Infect Dis. 2008 Jul 22;8:96
pubmed: 18647385
MMWR Recomm Rep. 1997 Apr 4;46(RR-8):1-24
pubmed: 9132580
Am J Epidemiol. 1999 Feb 1;149(3):282-9
pubmed: 9927225
Pathogens. 2020 Apr 03;9(4):
pubmed: 32260132
J Infect Dis. 2005 Aug 1;192(3):377-86
pubmed: 15995950
Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):785-791
pubmed: 30778705
Semin Respir Crit Care Med. 2005 Dec;26(6):563-74
pubmed: 16388428
PLoS One. 2013;8(4):e60273
pubmed: 23565216
Int J Infect Dis. 2015 Aug;37:30-5
pubmed: 25997673
Hum Vaccin Immunother. 2021 Oct 3;17(10):3670-3686
pubmed: 34106040
BMC Infect Dis. 2018 Apr 27;18(1):196
pubmed: 29699550
Expert Rev Vaccines. 2020 Dec;19(12):1141-1151
pubmed: 33428494
Vaccine. 1999 Jul 30;17 Suppl 1:S11-8
pubmed: 10471174
Inform Prim Care. 2011;19(3):135-45
pubmed: 22688222
Med Clin (Barc). 2013 Mar 2;140(5):223.e1-223.e19
pubmed: 23276610