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Incidence and Risk of Pneumococcal Pneumonia in Adults with Distinct Underlying Medical Conditions: A Population-Based Study

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Abstract

Purpose

This study investigated the incidence of pneumococcal pneumonia requiring hospitalisation among middle-aged and older adults with and without specific underlying medical conditions, evaluating the influence of these conditions in the risk of developing pneumonia.

Methods

Population-based prospective cohort study included 2,025,730 individuals ≥ 50 years around Catalonia, Spain. The Catalonian information system for the development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities and underlying medical conditions). Hospitalisations from pneumococcal pneumonia occurred among cohort members between 01/01/2015 and 31/12/2015 were collected from hospital discharge codes of 68 reference Catalonian hospitals. Cox regression was used to estimate the association between baseline conditions and the risk of developing pneumonia.

Results

Global incidence rate (IR) of hospitalised pneumococcal pneumonia was 82.8 cases per 100,000 persons-year. Maximum IRs (per 100,000 persons-year) emerged among persons with haematological neoplasia (837.4), immunodeficiency (709.2), HIV infection (474.7), severe renal disease (407.5) and chronic pulmonary disease (305.7). In the multivariable analyses, apart from increasing age, HIV infection (hazard ratio [HR] 6.78), haematological neoplasia (HR 6.30), prior all-cause pneumonia (HR 5.27), immunodeficiency (HR 4.57) and chronic pulmonary disease (HR 2.89) were the conditions most strongly associated with an increasing risk. Pneumococcal vaccination did not emerge associated with a reduced risk in our study population (nor PPsV23 neither PCV13).

Conclusion

Old age, immunocompromising conditions and chronic pulmonary/respiratory disease are major risk factors for pneumococcal pneumonia in adults. Our data underline the need for better prevention strategies in these persons.

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Data Availability

These data have been obtained from the Catalonian Health Institute Information System for the Development of Research in Primary Care (SIDIAP). Interested authors might obtain SIDIAP data (previous ethics and scientific approval by the ethics and clinical research committee of the Primary Care Research Institute Jordi Gol (IDIAP Jordi Gol)) addressing purposes to the Institution.

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Acknowledgement

We would like to acknowledge Timothy Bowring for his help in the production of this paper.

Funding

This work was supported by a grant from the “Fondo de Investigación Sanitaria” (FIS) of the “Instituto de Salud Carlos III” (call 2015) for the “Acción Estratégica en Salud 2013–2016 del Programa Estatal de Investigación Orientado a los Retos de la Sociedad”, framing in the “Plan Estatal de Investigación Científica y Técnica y de Innovación 2013–2016”; code file PI15/01230, cofinanced by the European Union through the “Fondo Europeo de Desarrollo Regional” (FEDER).

Author information

Authors and Affiliations

  1. Primary Health Care Service “Camp de Tarragona”, Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain

    A. Vila-Corcoles, O. Ochoa-Gondar, I. Hospital, E. Satue, J. Blade & C. de Diego

  2. Unitat de Suport a La Recerca of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain

    A. Vila-Rovira

  3. Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain

    M. Aragon

  4. Departament of Pneumology, Hospital Joan XXIII, Tarragona, Spain

    L. Esteban-Julvez & N. Chamorro

  5. Department of Laboratory and Microbiology, Hospital Joan XXIII, Tarragona, Spain

    F. Gomez-Bertomeu

  6. Department of Laboratory and Microbiology, Hospital Santa Tecla, Tarragona, Spain

    X. Raga

Authors
  1. A. Vila-Corcoles
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  2. O. Ochoa-Gondar
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  3. A. Vila-Rovira
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  5. L. Esteban-Julvez
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  7. I. Hospital
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  10. C. de Diego
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  12. X. Raga
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Contributions

AVC and OOG wrote and edited the paper; AVC, OOG, IH, ES, JB and CD designed the study; AVC, OOG, LEJ and NC assessed outcomes; MA, AVR, XR and FGB obtained the data; OOG and AVR did the statistical analyses. The two first listed authors contributed similarly to this manuscript.

Corresponding author

Correspondence to O. Ochoa-Gondar.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics Approval and Consent to Participate

The study was approved by the ethical committee of the Institution (ethic committee IDIAP Jordi Gol P14/134) and was conducted in accordance with the general principles for observational studies. Given this is a non-interventional study, an informed consent for all 2,025,730 study participants was not required. Data were anonymized and risk of identification was null.

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Appendix: Criteria Used to Define Comorbidities/Underlying Risk Conditions in the Study Population

Appendix: Criteria Used to Define Comorbidities/Underlying Risk Conditions in the Study Population

The following comorbidities and underlying risk conditions were established according to the presence of ICD-10 codes [International Classification of Diseases, 10th Revision] registered in the electronic primary care medical records of each cohort member at baseline:

  • Chronic pulmonary/respiratory disease it included chronic bronchitis/emphysema (J41-J44), asthma (J45-J46) and/or other chronic pulmonary diseases (P27, E84, J47)

  • Chronic heart disease it included congestive heart failure (I50), coronary artery disease (I20-I22, I25) and/or other chronic heart diseases (I05-I08, I11,I35-I37,I42, I51.7)

  • Diabetes mellitus (E10-E14).

  • Chronic liver disease it included chronic viral hepatitis (B18), cirrhosis (K74) and/or alcoholic hepatitis (K70))

  • Alcoholism (F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70)

  • Smoking (F17).

  • Anatomic or functional asplenia (D57, D73, Q89)

  • Primary immunodeficiency (D80-D84)

  • HIV infection (B20-B24)

  • Chronic renal disease it included nephrotic syndrome (N04, N39.1) and severe chronic renal failure (N18-N19 with glomerular filtration rate ≤ 30 ml/min)

  • Cancer it included solid organ or haematological neoplasia (C00 to C97) diagnosed within previous 5 years.

  • Immunosuppressive therapy it included long-term immunosuppressive medication and/or radiotherapy in the previous 12 months (coded according to specific SIDIAP codes H02AB [systemic corticosteroids] and L0* [antineoplasic agents, tumour necrosis factor antagonists and other immunomodulatory therapies]).

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Vila-Corcoles, A., Ochoa-Gondar, O., Vila-Rovira, A. et al. Incidence and Risk of Pneumococcal Pneumonia in Adults with Distinct Underlying Medical Conditions: A Population-Based Study. Lung 198, 481–489 (2020). https://doi.org/10.1007/s00408-020-00349-y

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