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Respiratory infection
Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project)
  1. Irene Rivero-Calle1,2,
  2. Miriam Cebey-López2,
  3. Jacobo Pardo-Seco2,
  4. José Yuste3,
  5. Esther Redondo4,
  6. Diego A Vargas5,
  7. Enrique Mascarós6,
  8. Jose Luis Díaz-Maroto7,
  9. Manuel Linares-Rufo8,
  10. Isabel Jimeno9,
  11. Angel Gil10,
  12. Jesus Molina11,
  13. Daniel Ocaña12 and
  14. Federico Martinón-Torres1,2
  15. on behalf of NEUMOEXPERTOS group
    1. 1Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
    2. 2Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
    3. 3Pneumococcal Unit of the Laboratory of Reference and Research in Bacterial Diseases Preventable by Vaccines, National Center of Microbiology and CIBER of Respiratory Diseases (CIBERES). Carlos III Health Institute, Madrid, Spain
    4. 4Preventive and Public Health Activities Group SEMERGEN, International Heath Center, Madrid, Spain
    5. 5Versatile Hospitalization Unit, Hospital de Alta Resolución El Toyo, Agencia Pública Sanitaria, Hospital de Poniente, Almería, Spain
    6. 6Health Department, Hospital Dr Peset, Primary Care Center Fuente de San Luís, Valencia, Spain
    7. 7Primary Care Health Center Guadalajara, Infectious Diseases Group SEMERGEN, Guadalajara, Spain
    8. 8Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain
    9. 9Primary Care Health Center Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain
    10. 10Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain
    11. 11Primary Care, Health Care Center Francia, Fuenlabrada, Madrid, Spain
    12. 12Primary Care, Health Care Center Algeciras, Algeciras, Spain
    1. Correspondence to Dr Federico Martinón-Torres; federico.martinon.torres{at}sergas.es

    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.

    • community-acquired pneumonia
    • vaccine-preventable diseases
    • incidence
    • risk factors
    • primary care

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/bmjresp-2018-000359

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      Footnotes

      • IR-C, MC-L, JP-S and FM-T contributed equally.

      • Collaborators NEUMOEXPERTOS group is national working group on pneumonia prevention endorsed by the Healthcare Research Insitute of Santiago de Compostela (Spain) and consisting of: F Martinón-Torres, D Vargas, E Mascarós, E Redondo, J Molina, JL Díaz Maroto, M Linares, A Gil, D Ocaña, I Rivero-Calle, Isabel Jimeno, José Yuste.

      • Contributors IR-C, JP-S, MC-L and FM-T drafted the manuscript. JP-S performed the statistical analysis. All of the authors helped to draft the manuscript. All authors read and approved the final manuscript.

      • Funding This study has been partially sponsored by an unrestricted grant from Pfizer to the Healthcare Research Institute of Santiago de Compostela. The corresponding author had full access to all the data in the study and was ultimately responsible for the decision to submit this work for publication. FM-T’s research activities have been supported by grants from Instituto Carlos III (Intensificación de la actividad investigadora, ISCIII/PI16/01569 and FIS PI13/02382) from National Plan I+D+I and FEDER funds and 2016-PG071 Consolidación e Estructuración REDES 2016GI-1344 G3VIP (Grupo Gallego de Genética Vacunas Infecciones y Pediatría, ED341D R2016/021).

      • Disclaimer The sponsor had no role in the design, data collection, data analysis, data interpretation or writing of the report.

      • 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.

      • Patient consent for publication Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement Most of the data generated or analysed during this study are included in this published article (and its supplementary information files), although restrictions apply to the availability of some data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of BIFAP database.