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Observational Study
. 2019 Mar 12;6(1):e000359.
doi: 10.1136/bmjresp-2018-000359. eCollection 2019.

Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project)

Irene Rivero-Calle #  1   2 , Miriam Cebey-López #  2 , Jacobo Pardo-Seco #  2 , José Yuste  3 , Esther Redondo  4 , Diego A Vargas  5 , Enrique Mascarós  6 , Jose Luis Díaz-Maroto  7 , Manuel Linares-Rufo  8 , Isabel Jimeno  9 , Angel Gil  10 , Jesus Molina  11 , Daniel Ocaña  12 , Federico Martinón-Torres #  1   2
Affiliations
Observational Study

Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project)

Irene Rivero-Calle et al. BMJ Open Respir Res. .

Abstract

Introduction: Information about community-acquired pneumonia (CAP) risk in primary care is limited. We assess different lifestyle and comorbid conditions as risk factors (RF) for CAP in adults in primary care.

Methods: A retrospective-observational-controlled study was designed. Adult CAP cases diagnosed at primary care in Spain between 2009 and 2013 were retrieved using the National Surveillance System of Primary Care Data (BiFAP). Age-matched and sex-matched controls were selected by incidence density sampling (ratio 2:1). Associations are presented as percentages and OR. Binomial regression models were constructed to avoid bias effects.

Results: 51 139 patients and 102 372 controls were compared. Mean age (SD) was 61.4 (19.9) years. RF more significantly linked to CAP were: HIV (OR [95% CI]: 5.21 [4.35 to 6.27]), chronic obstructive pulmonary disease (COPD) (2.97 [2.84 to 3.12]), asthma (2.16 [2.07,2.26]), smoking (1.96 [1.91 to 2.02]) and poor dental hygiene (1.45 [1.41 to 1.49]). Average prevalence of any RF was 82.2% in cases and 69.2% in controls (2.05 [2.00 to 2.10]). CAP rate increased with the accumulation of RF and age: risk associated with 1RF was 1.42 (1.37 to 1.47) in 18-60-year-old individuals vs 1.57 (1.49 to 1.66) in >60 years of age, with 2RF 1.88 (1.80 to 1.97) vs 2.35 (2.23, 2.48) and with ≥ 3 RF 3.11 (2.95, 3.30) vs 4.34 (4.13 to 4.57).

Discussion: Prevalence of RF in adult CAP in primary care is high. Main RFs associated are HIV, COPD, asthma, smoking and poor dental hygiene. Our risk stacking results could help clinicians identify patients at higher risk of pneumonia.

Keywords: community-acquired pneumonia; incidence; primary care; risk factors; vaccine-preventable diseases.

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Conflict of interest statement

Competing interests: FM-T and/or his institution has received research grants and/or honoraria as a consultant/advisor and/or speaker and for conducting vaccine trials from GlaxoSmithKline, Sanofi Pasteur, MSD, Pfizer, Novartis, Novavax, Regeneron, Janssen and MedImmune Inc. ER has received honoraria as a consultant/advisor and/or speaker, as well as grants for attending to conferences and practical courses from GlaxoSmithKline, Sanofi Pasteur MSD, Merck, Sanofi Pasteur, Pfizer and Novartis. IR-C has received honoraria as a consultant/advisor and/or speaker, as well as grants for attending to conferences and practical courses from GlaxoSmithKline, Sanofi Pasteur, MSD, Merck and Pfizer. EM has received honoraria as a consultant/advisor and/or speaker as well as grants for attending to conferences and practical courses from GlaxoSmithKline, Pfizer and Novartis. JM has received honoraria as a consultant/advisor and/or speaker, as well as grants for attending to conferences and practical courses from Astra-Zeneca, GlaxoSmithKline, Menarini, Novartis, Pfizer and Rovi. None declared for the rest of the authors.

Figures

Figure 1
Figure 1
Coefficients for the risk factors studied. Sex and age were covariables included in both analysis as confounder variables.
Figure 2
Figure 2
Distribution of different risk factors and comorbidities, stratified by age, in cases and controls.
Figure 3
Figure 3
Risk factors studied stratified by age and sex, and expressed as log OR.
See this image and copyright information in PMC

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