Abstract
Background: Pneumococcal pneumonia is a disease of the extremes of age. However, as other traditional risk factors for pneumococcal pneumonia also increase with older age, it is unclear if older age itself should be an indication for pneumococcal vaccination. Therefore, we assessed the effect of age on risk for hospitalization for pneumonia and for pneumococcal pneumonia.Methods: Using a national hospitalization dataset, all patients ≥16 years hospitalized in a Swiss hospital with a diagnosis of pneumonia or pneumococcal pneumonia between 2002 and 2015 were included. Multivariable logistic regression analysis was used to test the association between age (≥50 or ≥65 years) and hospitalization for pneumonia or pneumococcal pneumonia after adjusting for pneumococcal vaccine indications. Similar analyses were performed for effect of age on length of stay (LOS) and mortality.Results: Among a total of 17,619,016 hospitalizations a diagnosis of pneumonia was present in 421,760 (2.4%) and a diagnosis of pneumococcal pneumonia in 21,610 (0.12%). Age ≥50 years (OR: 3.52 and 2.12, respectively; p for both <0.001) and age ≥65 years (OR: 2.98 and 1.80, respectively; p for both <0.001) as well as most Swiss pneumococcal vaccine indications were independent predictors of hospitalization with a pneumonia and pneumococcal pneumonia diagnosis, respectively. Older age with both age cut-offs were associated with increased LOS (≥50 years: aRR: 1.19 and 1.24, respectively; age ≥65 years: aRR: 1.60 and 1.20, respectively; p < 0.001 for all) and mortality (≥50 years: aOR: 4.73 and 2.84, respectively; age ≥65 years: aOR: 2.38 and 2.69, respectively, p < 0.001 for all) in patients with a pneumonia and pneumococcal pneumonia diagnosis, respectively. The effects of pneumococcal vaccine indications decreased with older age. The incidences of hospitalizations with a pneumonia diagnosis and a pneumococcal pneumonia diagnosis increased significantly from the pre-vaccine era to the PCV7 era and the PCV13 era (p for trend for both analyses <0.001).Conclusion: This study confirms the Swiss indications for pneumococcal vaccination as independent risk factors for pneumonia hospitalizations. Older age itself should be considered as an additional vaccine indication. Pneumonia and pneumococcal pneumonia in adults have increased despite pneumococcal vaccination in children.
Highlights
Lower respiratory tract infections and pneumonia as its most severe manifestation, are the leading infectious disease related causes of death worldwide [1]
This study period included a total of 17,619,016 hospitalization cases among which 421,760 cases (2.4%) included a pneumonia diagnosis and 21,610 (0.12%) a diagnosis of pneumococcal pneumonia
In all bivariate analyses with the outcome pneumonia hospitalization, the interaction term of risk factor∗age was negatively correlated with the risk of pneumonia hospitalization (OR < 1) indicating a decreasing effect of each risk factor with increasing age
Summary
Lower respiratory tract infections and pneumonia as its most severe manifestation, are the leading infectious disease related causes of death worldwide [1]. The age-related incidence of pneumococcal disease shows a U-shaped curve with highest risks in young children and the elderly [5]. Older age itself has been shown to be an independent risk factor for pneumonia [6]. It was shown that non-immunocompromising conditions which predispose to pneumococcal disease, such as diabetes mellitus, chronic heart and lung disease, increase with age in elderly adults, and play an increasing role as a pneumonia risk factor [7, 8]. The presence of these non-immunocompromising conditions, especially if occurring concomitantly, conferred very high risks. Pneumococcal pneumonia is a disease of the extremes of age. As other traditional risk factors for pneumococcal pneumonia increase with older age, it is unclear if older age itself should be an indication for pneumococcal vaccination. We assessed the effect of age on risk for hospitalization for pneumonia and for pneumococcal pneumonia
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