成人肺炎链球菌性肺炎的发病率及危险因素：一项基于人群的研究。
Incidence and risk factors of pneumococcal pneumonia in adults: a population-based study.
机构信息
Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain.
Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain.
出版信息
BMC Pulm Med. 2023 Jun 8;23(1):200. 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.
背景
肺炎链球菌引起的感染，主要是侵袭性肺炎球菌病（IPD）和肺炎球菌肺炎（PP），是全球范围内的一个主要公共卫生问题。本研究调查了加泰罗尼亚≥50 岁人群中与特定基础疾病/合并症有关和无关的肺炎球菌性肺炎（PP）的基于人群的发病率和风险，并研究了单一和多种合并症对患 PP 风险的影响。
方法
这是一项基于人群的队列研究，涉及西班牙加泰罗尼亚 2059645 名≥50 岁的人群，他们在 2017 年 1 月 1 日至 2018 年 12 月 31 日期间进行了回顾性随访。使用加泰罗尼亚初级保健发展研究信息系统（SIDIAP）确定队列的基线特征（合并症/基础疾病），并从 68 家转诊加泰罗尼亚医院的出院代码（ICD-10：J13）中收集 PP 病例。
结果
全球发病率（IR）为每 100000 人年 90.7 例，病死率（CFR）为 7.6%（272/3592）。既往 IPD 或所有原因肺炎、血液系统恶性肿瘤、HIV 感染、肾脏疾病、慢性呼吸道疾病、肝脏疾病、心脏病、酒精中毒、实体癌和糖尿病史的人群中 IR 最高，分别为 475.0、423.7、403.7、384.9、314.7、232.5、221.4、204.8、186.2 和 159.6。IR 分别为 42.1、89.9、201.1、350.9、594.3 和 761.2，在分别有 0、1、2、3、4 和≥5 种合并症的人群中。多变量分析显示，HIV 感染（危险比 [HR]：5.16；95%CI：3.57-7.46）、既往所有原因肺炎（HR：3.96；95%CI：3.45-4.55）、血液系统恶性肿瘤（HR：2.71；95%CI：2.06-3.57）、慢性呼吸道疾病（HR：2.66；95%CI：2.47-2.86）和既往 IPD（HR：2.56；95%CI：2.03-3.24）是 PP 的主要预测因素。
结论
除了年龄增长和免疫功能低下（经典上被认为是高危情况）外，既往 IPD/肺炎、慢性肺部/呼吸道疾病和/或并存的多种合并症（即两种或两种以上基础疾病）也是成年人患 PP 的主要危险因素，其风险接近免疫功能低下者。重新定义 PP 的风险类别，将上述所有情况都纳入高危类别，可能有必要改善中年及以上人群的预防策略。
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