The Increased Risk for Postinfluenza Pneumonia Among Cystic Fibrosis Carriers-A Population-Based Study

Abstract

Background: Influenza is strongly associated with an increased risk for subsequent bacterial pneumonia. Moreover, cystic fibrosis (CF) carriers are at increased risk for some pulmonary infections. The purpose of this study was to determine whether CF carriers are at greater risk for postinfluenza pneumonia than noncarriers.

Methods: Using MarketScan insurance claims data (2001-2023), we identified a study cohort of 38 047 CF carriers and a cohort of 380 470 matched controls. We conducted 2 analyses using these cohorts. First, we assessed individual-level risk for experiencing pneumonia following an influenza infection. Second, because many cases of influenza often do not result in medical visits, we conducted a cohort-level analysis comparing the weekly incidence of pneumonia between CF carriers and noncarriers while accounting for weekly Centers for Disease Control and Prevention-reported influenzalike illnesses across multiple influenza seasons.

Results: At an individual level, we found that the odds of developing pneumonia following a diagnosis of influenza were approximately 34% greater among CF carriers compared with noncarriers. Second, we found that while the incidence of influenza is not elevated among CF carriers, the incidence rate of pneumonia was about 55% greater among CF carriers compared with our control population.

Conclusions: Because 2%-11% of the population acquires influenza each year, and because there are >10-15 million CF carriers in the United States alone, a substantial number of cases of secondary pneumonia may be attributable to the CF carrier state.

Keywords: cystic fibrosis carrier; influenza; pneumonia.

Figure 1.

Monthly influenza and pneumonia incidence (per 10 000 enrollees) among cystic fibrosis (CF) carrier and matched control cohorts. There is little to no difference in monthly influenza incidence between CF carriers and controls. However, CF carriers tended to have a consistently higher incidence of pneumonia. The incidence for CF carriers before 2009 is less stable because of scarcity of cases of influenza and pneumonia; this is the period when the study cohort is less populated due to a lower frequency of genetic testing (see Supplementary Figure 1 for a summary of the size of the study population across time).