Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut 06520, USA.
J Am Geriatr Soc. 2013 Jul;61(7):1111-8. doi: 10.1111/jgs.12325. Epub 2013 Jun 17.
To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community-dwelling older adults.
Prospective observational cohort study.
Memphis, Tennessee, and Pittsburgh, Pennsylvania.
Of 3,075 well-functioning community-dwelling adults aged 70 to 79 enrolled in the Health, Aging, and Body Composition Study from 1997 to 1998, 1,441 had complete data in the data set of all variables used, a dental examination within 6 months of baseline, and were eligible for this study.
The primary outcome was pneumonia requiring hospitalization through 2008.
Of 1,441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male sex (hazard ratio (HR) = 2.07, 95% confidence interval (CI) = 1.51-2.83), white race (HR = 1.44, 95% CI = 1.03-2.01), history of pneumonia (HR = 3.09, 95% CI = 1.86-5.14), pack-years of smoking (HR = 1.006, 95% CI = 1.001-1.011), and percentage of predicted forced expiratory volume in 1 minute (moderate vs mild lung disease or normal lung function, HR = 1.78, 95% CI = 1.28-2.48; severe lung disease vs mild lung disease or normal lung function, HR = 2.90, 95% CI = 1.51-5.57) were nonmodifiable risk factors for pneumonia. Incident mobility limitation (HR = 1.77, 95% CI = 1.32-2.38) and higher mean oral plaque score (HR = 1.29, 95% CI = 1.02-1.64) were modifiable risk factors for pneumonia. Average attributable fractions revealed that 11.5% of cases of pneumonia were attributed to incident mobility limitation and 10.3% to a mean oral plaque score of 1 or greater.
Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors that 22% of pneumonia requiring hospitalization could be attributed to. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults.
确定针对需要住院治疗的社区老年人肺炎的新型可改变风险因素，重点关注口腔卫生。
前瞻性观察队列研究。
田纳西州孟菲斯和宾夕法尼亚州匹兹堡。
1997 年至 1998 年期间，健康、衰老和身体成分研究共纳入 3075 名功能正常的 70 至 79 岁社区居住成年人，其中 1441 人在基线后 6 个月内完成了所有变量数据组的完整数据、牙科检查，且符合本研究条件。
主要结局是需要住院治疗的肺炎。
在 1441 名参与者中，有 193 人因肺炎住院。在多变量模型中，男性（危险比[HR] = 2.07，95%置信区间[CI] = 1.51-2.83）、白人（HR = 1.44，95% CI = 1.03-2.01）、肺炎病史（HR = 3.09，95% CI = 1.86-5.14）、吸烟包年数（HR = 1.006，95% CI = 1.001-1.011）和预计用力呼气量的百分比 1 分钟（中度与轻度肺部疾病或正常肺功能，HR = 1.78，95% CI = 1.28-2.48；严重肺部疾病与轻度肺部疾病或正常肺功能，HR = 2.90，95% CI = 1.51-5.57）是肺炎的不可改变风险因素。新发活动受限（HR = 1.77，95% CI = 1.32-2.38）和更高的平均口腔斑块评分（HR = 1.29，95% CI = 1.02-1.64）是肺炎的可改变风险因素。平均归因分数显示，11.5%的肺炎病例归因于新发活动受限，10.3%归因于平均口腔斑块评分等于或大于 1。
新发活动受限和更高的平均口腔斑块评分是 22%需要住院治疗的肺炎可归因的两个可改变风险因素。这些数据表明，为社区居住的老年人预防肺炎提供了创新机会。
