Influència dels hàbits tòxics, estils de vida, condicions ambientals i la vacuna antipneumocòccica en laparició de la pneumònia adquirida a la comunitat en adults
Context: Although community-acquired pneumonia (CAP) is a well-known and widely studied disease, morbimortality is high and knowledge of the factors that favor CAP limited. CAP is a disease with high incidence, cost and mortality (especially among the elderly) and disputed clinical management. If to all this one adds antibiotic-resistant bacteria it is hardly surprising that the prevention perspective of the disease is gaining importance.
Objectives: to determine the risk factors of acquiring CAP that are related to toxic habits or modifiable lifestyles, environmental, working and living conditions, as well as the effect of the antipneumococcal vaccine in preventing CAP, in a population of over 14 years of age.
Methods: A population-based, multicenter, coordinated, observational, case-control study was designed with a population base of 860,000 people of over 14 years of age. This was the population needed to detect 1,500 cases of CAP in one year. Sixty-four primary health care clinics in Catalonia, Andorra, Valencia and the Balearic Islands participated in the study. All cases of CAP, diagnosed according to strict clinical, radiological and evolutional criteria between November 1999 and November 2000, were included in the study. A control matched by age, sex and primary health care clinic was selected for each case, following a random sampling process from the town census. All participants were given a detailed questionnaire on the risk factors of CAP which covered tobacco and alcohol use, occupational exposures, living and housing conditions, vaccines, and medical history and comorbidities.
Results: During the study period, 1,336 cases of CAP were identified and enrolled (97% participation) and 1,326 controls were selected (63% participation) with an average age of 57 years and a slight predominance of men (53%). The accumulated incidence observed was of 1.6 cases/1,000 inhabitants/year with a marked seasonal relation reflected by the incidence in January being nearly 6 times greater than the incidence in July or August. With regard to comorbidity, a significant association was found between CAP and upper respiratory infections within the previous month, cardiac insufficiency, chronic bronchitis, and cancer, but not with diabetes, stroke, or chronic renal insufficiency. A significant association was found between smoking and CAP, independent of the above-mentioned comorbidities, and a dose-response relation between CAP and the intensity and duration of the smoking habit and the total number of packets smoked. With regard to passive smoking, a clear interaction between exposure and age was observed, there being no effect on people under 60 years of age (OR=1.0) but a significant effect was observed in people over 60 years (OR=1.52) with a population attributable fraction of 10%. Regarding alcohol consumption, a significant effect was observed for men only and when consumption was greater than 80 g/day (OR=2.34), no increased risk being observed for lower consumption even when daily. Other variables associated with CAP were occupational exposure to dust (OR=1.65), animals, offal, or excrements (OR=3.27) and sharp changes in temperature (OR=3.27), living with more than 10 people in the home (OR=2.20), living or working with children under 15 years of age (OR=1.48), or having pets (OR=1.37). Multivariate analysis where the effect of vaccines was adjusted for comorbidities showed a significant protector effect for both the influenza vaccine (OR=.76) and the antipneumococcal vaccine (OR=.55).
Conclusions: This study identified several modifiable risk factors of CAP which should allow preventative measures to be designed to reduce incidence. New scientific evidence on the effectiveness of the influenza and antipneumococcal vaccines in the prevention of CAP has also been presented.
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Advisor:Almirall, Jordi; Moreno, Víctor
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:418 departament de pediatria obstetricia i ginecologia
Date of Publication:06/11/2004