Risk factors for pneumococcal disease in persons with chronic medical conditions: Results from the LIFE Study

Haruhisa Fukuda,Hiroaki Onizuka,Naoaki Nishimura,Kosuke Kiyohara

doi:10.1016/j.ijid.2021.12.365

Abstract

ObjectivesThis study aimed to identify the risk factors for pneumococcal disease. MethodsThe study was performed using insurance claims data from the residents of 12 Japanese municipalities. Based on recorded diagnoses, we identified chronic medical conditions in each patient between April 2015 and March 2016 and examined the subsequent occurrence of a pneumococcal disease from April 2016 onward. Cox proportional hazards models were used to estimate the hazard ratio of each chronic medical condition for a pneumococcal disease occurrence. ResultsThe study was conducted on 732,235 patients, of whom, 61,306 (8.4%) were aged 0-18 years, 184,367 (25.2%) were aged 19-49 years, 126,078 (17.2%) were aged 50-64 years, and 360,484 (49.2%) were aged ≥65 years. A higher number of conditions was associated with a higher incidence of pneumococcal disease. Significant risk factors for pneumococcal disease in all patients included chronic heart disease, chronic lung disease, diabetes mellitus, cancer, and chronic renal disease. Furthermore, chronic lung disease, diabetes mellitus, aspiration pneumonia, and immunosuppressant use were risk factors among patients aged 50-64 years. ConclusionsPersons aged 50-64 years with multiple chronic medical conditions or with specific conditions are at a higher risk of developing pneumococcal disease, indicating a need to consider their inclusion in routine vaccination programs.

Highlights

Streptococcus pneumoniae, a gram-positive bacterium, is a major cause of various non-invasive pneumococcal diseases such as pneumonia, otitis media, and sinusitis across all age groups
Through an analysis of National Health Insurance and Latter-Stage Elderly Healthcare System enrollees residing in 12 Japanese municipalities, this study calculated the incidence rates and identified the risk factors for pneumococcal disease
Our results showed that multimorbidity with ≥3 chronic medical conditions was significantly associated with a higher hazard of pneumococcal disease among subjects aged 50–64 years

Summary

Introduction

Streptococcus pneumoniae, a gram-positive bacterium, is a major cause of various non-invasive pneumococcal diseases such as pneumonia, otitis media, and sinusitis across all age groups. Children aged ≤5 years and older persons aged ≥65 years have a higher susceptibility to S. pneumoniae infections, and Japan has established routine pneumococcal vaccination programs for these populations. S. pneumoniae infections can occur in people aged 6–64 years (Morimoto et al, 2015), and there is a need to identify at-risk subgroups within this population and explore preventive measures. If the risk of S. pneumoniae infections is found to be higher in persons with chronic medical conditions (such as diabetes, cardiovascular disease, pulmonary disease, renal disease, and rheumatic disease) (Centers for Disease Control and Prevention 1997), this information could be used to expand vaccination strategies to include these subgroups. This study was conducted to identify the risk factors for pneumococcal disease in a Japanese population, with a focus on the types of chronic medical conditions and the impact of having multiple conditions (i.e., stacked risks)

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