Influence of Older Age and Other Risk Factors on Pneumonia Hospitalization in Switzerland in the Pneumococcal Vaccine Era
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abstract
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Pneumococcal pneumonia is a disease of the extremes of age. However,
as other traditional risk factors for pneumococcal pneumonia also
increase with older age, it is unclear if older age itself should be
an indication for pneumococcal vaccination. Therefore, we assessed
the effect of age on risk for hospitalization for pneumonia and for
pneumococcal pneumonia. Using a national hospitalization dataset,
all patients ≥16 years hospitalized in a Swiss hospital with a
diagnosis of pneumonia or pneumococcal pneumonia between 2002 and
2015 were included. Multivariable logistic regression analysis was
used to test the association between age (≥50 or ≥65 years)
and hospitalization for pneumonia or pneumococcal pneumonia after
adjusting for pneumococcal vaccine indications. Similar analyses
were performed for effect of age on length of stay (LOS) and
mortality. Among a total of 17,619,016 hospitalizations a diagnosis
of pneumonia was present in 421,760 (2.4%) and a diagnosis of
pneumococcal pneumonia in 21,610 (0.12%). Age ≥50 years (OR: 3.52
and 2.12, respectively; for both <0.001) and age ≥65 years
(OR: 2.98 and 1.80, respectively; for both <0.001) as well as
most Swiss pneumococcal vaccine indications were independent
predictors of hospitalization with a pneumonia and pneumococcal
pneumonia diagnosis, respectively. Older age with both age cut-offs
were associated with increased LOS (≥50 years: aRR: 1.19 and
1.24, respectively; age ≥65 years: aRR: 1.60 and 1.20,
respectively; < 0.001 for all) and mortality (≥50 years: aOR:
4.73 and 2.84, respectively; age ≥65 years: aOR: 2.38 and 2.69,
respectively, < 0.001 for all) in patients with a pneumonia and
pneumococcal pneumonia diagnosis, respectively. The effects of
pneumococcal vaccine indications decreased with older age. The
incidences of hospitalizations with a pneumonia diagnosis and a
pneumococcal pneumonia diagnosis increased significantly from the
pre-vaccine era to the PCV7 era and the PCV13 era ( for trend for
both analyses <0.001). This study confirms the Swiss indications
for pneumococcal vaccination as independent risk factors for
pneumonia hospitalizations. Older age itself should be considered as
an additional vaccine indication. Pneumonia and pneumococcal
pneumonia in adults have increased despite pneumococcal vaccination
in children.
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citation
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Albrich W, Rassouli F, Waldeck F, Berger C, Baty F. Influence of
Older Age and Other Risk Factors on Pneumonia Hospitalization in
Switzerland in the Pneumococcal Vaccine Era. Front Med (Lausanne)
2019; 6:286.
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type
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journal paper/review (English)
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date of publishing
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05-12-2019
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journal title
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Front Med (Lausanne) (6)
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ISSN print
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2296-858X
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pages
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286
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PubMed
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31867337
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DOI
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10.3389/fmed.2019.00286
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