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. 2023 Apr 21;10(5):ofad222.
doi: 10.1093/ofid/ofad222. eCollection 2023 May.

Factors Associated With the Development of Bacterial Pneumonia Related to Seasonal Influenza Virus Infection: A Study Using a Large-scale Health Insurance Claim Database

Masahiro Shirata  1 , Isao Ito  1 , Taisuke Jo  2   3 , Tomohide Iwao  4 , Issei Oi  1 , Nobuyoshi Hamao  1 , Kensuke Nishioka  1 , Hayato Yamana  2 , Takahide Nagase  3 , Hideo Yasunaga  5 , Toyohiro Hirai  1
Affiliations

Factors Associated With the Development of Bacterial Pneumonia Related to Seasonal Influenza Virus Infection: A Study Using a Large-scale Health Insurance Claim Database

Masahiro Shirata et al. Open Forum Infect Dis. .

Abstract

Background: Influenza-related bacterial pneumonia is a leading complication of influenza infection. However, the differences in the incidence rates and risk factors associated with concomitant viral/bacterial pneumonia (CP) and secondary bacterial pneumonia following influenza (SP) remain unclear. This study aimed to clarify the incidence rates of CP and SP following seasonal influenza and identify factors associated with their development.

Methods: This retrospective cohort study was conducted using the JMDC Claims Database, a health insurance claims database in Japan. All patients aged <75 years who developed influenza during 2 consecutive epidemic seasons, 2017/2018 and 2018/2019, were analyzed. CP was defined as bacterial pneumonia diagnosed between 3 days before and 6 days after the date of influenza diagnosis, and SP was defined as pneumonia diagnosed 7-30 days after the date of diagnosis. Multivariable logistic regression analyses were performed to identify factors associated with the development of CP and SP.

Results: Among the 10 473 014 individuals registered in the database, 1 341 355 patients with influenza were analyzed. The average age at diagnosis (SD) was 26.6 (18.6) years. There were 2901 (0.22%) and 1262 (0.09%) patients who developed CP and SP, respectively. Age 65-74 years, asthma, chronic bronchitis/emphysema, cardiovascular disease, renal disease, malignant tumor, and immunosuppression were significant risk factors for both CP and SP, whereas cerebrovascular disease, neurological disease, liver disease, and diabetes were risk factors specific to CP development.

Conclusions: The results determined the incidence rates of CP and SP and identified their risk factors, such as older age and comorbidities.

Keywords: bacterial pneumonia; database; risk factor; seasonal influenza.

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Conflict of interest statement

Potential conflicts of interest. M.S., I.I., T.I., I.O., N.H., K.N., T.N., H.Yas., T.H.: no conflict. T.J. and H.Yam. have academic affiliations with the Department of Health Services Research, which is a cooperative program between the University of Tokyo and Tsumura and Company, outside the submitted work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Flowchart of patients identified for the main analysis. Abbreviation: ICD-10, International Classification of Diseases and Related Health Problems, 10th Revision.
Figure 2.
Figure 2.
The number of patients with bacterial pneumonia diagnosed between 30 days before and 30 days after the date of influenza diagnosis, which was designated as the index date (day 0). Pre-influenza pneumonia, concomitant pneumonia, and secondary pneumonia were defined as bacterial pneumonia diagnosed between 30 and 4 days before the index date, between 3 days before and 6 days after the index date, and between 7 and 30 days after the index date, respectively.
See this image and copyright information in PMC

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