Influence of chronic illnesses and underlying risk conditions on the incidence of pneumococcal pneumonia in older adults.

OBJECTIVE: To investigate hospitalizations from pneumococcal pneumonia in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing pneumonia. METHODS: Population-based cohort study involving 27,204 individuals ≥ 60 years old in Southern Catalonia, Spain. All cases of hospitalization from pneumococcal pneumonia (bacteremic and nonbacteremic) were collected since 01/12/2008 until 30/11/2011. Cox regression was used to calculate hazards ratio (HR) and estimate the association between baseline conditions and the risk of developing pneumococcal pneumonia. RESULTS: Maximum incidences (per 1000 person-years) appeared among patients with history of prior pneumonia (14.6), nursing home residents (12.8), persons with immunodeficiency/asplenia (7.7) and patients with chronic pulmonary disease (7.6). In multivariable analysis, age (HR: 1.05), nursing home residence (HR: 4.59), history of prior pneumonia (HR: 3.58), stroke (HR: 2.50), chronic heart disease (HR: 1.53), chronic pulmonary disease (HR: 4.09), diabetes mellitus (HR: 1.66), smoking (HR: 1.69) and immunosuppressive medication (HR: 1.87) appeared significantly associated with an increased risk of pneumococcal pneumonia. CONCLUSION: Our data support that nursing home residence, chronic pulmonary disease and immunocompromising conditions are the underlying conditions most strongly associated with an increasing risk of pneumococcal pneumonia in older adults. This data underline the need for better prevention strategies among these persons.

[Incidence and lethality of invasive pneumococcal disease in Tarragona, Spain, 2006-2009]. / Incidencia y letalidad de infecciones neumocócicas invasivas en la región de Tarragona, 2006-2009.

An epidemiological study was conducted on all cases of invasive pneumococcal disease (IPD) diagnosed in Tarragona, Spain, between 1 January 2006 and 31 December 2009. A total of 286 IPD cases were observed, which was an overall incidence of 21.2 episodes per 100,000 persons-year (95% CI: 16.6-26.9). Incidence rates were 26.3/100,000 (95% CI: 14.4-44.3) among children, 12.2/100,000 (95% CI: 8.2-17.6) among patients between 15-64 years and 59.6/100,000 (95% CI: 40.0-85.8) in those ≥65 years. Overall lethality rate was 7.3% (none in children, 3.4% among patients 15-64 years, and 14.8% among patients ≥65 years; p<0.001).