Incidence and risk factors of pneumococcal pneumonia in adults: a population-based study

• Published in: BMC pulmonary medicine Vol. 23; no. 1; pp. 200 - 11
• Main Authors: Ochoa-Gondar, Olga, Torras-Vives, Verónica, de Diego-Cabanes, Cinta, Satué-Gracia, Eva M., Vila-Rovira, Angel, Forcadell-Perisa, María J., Ribas-Seguí, Domingo, Rodríguez-Casado, Clara, Vila-Córcoles, Angel
• Format: Journal Article
• Language: English
• Published: London BioMed Central 08.06.2023; BioMed Central Ltd; BMC
• Subjects: Adults; Aged; Aged patients; Alcoholism; Antigens; Blood cancer; Cardiovascular disease; Care and treatment; Chronic illnesses; Chronic infection; Codes; Cohort Studies; Comorbidity; Critical Care Medicine; Demographic aspects; Diabetes; Diabetes mellitus; Diagnosis; Dosage and administration; Fatalities; Health aspects; Heart diseases; Hematology; HIV; Hospitalization; Hospitals; Human immunodeficiency virus; Humans; Immunization; Immunocompromised host; Incidence; Influenza; Intensive; Internal Medicine; Kidney diseases; Liver diseases; Lung diseases; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multimorbidity; Neoplasms - complications; Older people; Pneumococcal Infections - epidemiology; Pneumococcal pneumonia; Pneumococcal vaccine; Pneumococcal Vaccines; Pneumology/Respiratory System; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - prevention & control; Population; Population studies; Population-based studies; Prevention; Primary care; Public health; Pulmonology; Respiratory diseases; Retrospective Studies; Risk Factors; Streptococcus infections; Vaccines; Spain; Adults; Pneumococcal pneumonia; Risk factors; Incidence; Multimorbidity
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-023-02497-2

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 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 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 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.