Imai Kentaro, Petigara Tanaz, Kohn Melvin A, Nakashima Kei, Aoshima Masahiro, Shito Akihito, Kanazu Shinichi
MSD K.K., Tokyo, Japan.
Merck & Co., Inc, Kenilworth, New Jersey, USA.
BMJ Open. 2018 Mar 2;8(3):e018553. doi: 10.1136/bmjopen-2017-018553.
To quantify the risk of pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) in adults aged ≥19 years with underlying medical conditions compared with healthy adults of the same age in Japan.
An observational, retrospective, cohort study using two healthcare claims databases in Japan: Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases.
A total of 10.4 million individuals, representing 9.3 million person-years of follow-up, were included in the analysis. Eleven medical conditions as well as PP and IPD were identified by the International Statistical Classification of Diseases and Related Health Problems version 10 diagnostic codes and/or local disease codes used in Japan.
Adjusted rate ratios (RRs) for PP and IPD in adults with a medical condition versus adults without any medical condition were calculated using multivariate Poisson regression models with age and/or sex as covariates.
In the JMDC and MDV databases, respectively, adults ≥19 years with a medical condition (RRs for PP: 3.3 to 13.4, 1.7 to 5.2; RRs for IPD: 12.6 to 43.3, 4.4 to 7.1), adults with two or more medical conditions (PP: 11.6, 2.8; IPD: 18.7, 5.8) and high-risk adults (PP: 12.9, 1.8; IPD: 29.7, 4.0) were at greater risk of PP and IPD compared with their healthy counterparts. Adults aged 50-64 years with an underlying medical condition (PP rate: 38.6 to 212.1 per 100 000 person-years) had a higher rate of PP than those aged ≥65 years without any condition (PP rate: 13.2 to 93.0 per 100 000 person-years).
Adults of all ages with an underlying medical condition are at greater risk of PP and IPD compared with adults without any medical condition. This risk increases with the number of underlying medical conditions. Our results support extending pneumococcal vaccination to younger adults with an underlying medical condition, especially those aged 50-64 years.
量化日本≥19岁有基础疾病的成年人与同龄健康成年人相比发生肺炎球菌肺炎（PP）和侵袭性肺炎球菌病（IPD）的风险。
一项观察性、回顾性队列研究，使用日本的两个医疗保健理赔数据库：日本医疗数据中心（JMDC）和医疗数据愿景（MDV）数据库。
共有1040万人纳入分析，随访人年数达930万人年。通过国际疾病分类第10版诊断代码和/或日本使用的当地疾病代码确定了11种疾病以及PP和IPD。
使用以年龄和/或性别作为协变量的多变量泊松回归模型，计算有基础疾病的成年人与无基础疾病的成年人中PP和IPD的调整率比（RRs）。
在JMDC和MDV数据库中，≥19岁有基础疾病的成年人（PP的RRs：3.3至13.4、1.7至5.2；IPD的RRs：12.6至43.3、4.4至7.1）、有两种或更多基础疾病的成年人（PP：11.6、2.8；IPD：18.7、5.8）以及高危成年人（PP：12.9、1.8；IPD：29.7、4.0）与健康同龄人相比，发生PP和IPD的风险更高。有基础疾病的50 - 64岁成年人（PP发病率：每10万人年38.6至212.1例）的PP发病率高于无基础疾病的≥65岁成年人（PP发病率：每10万人年13.2至93.0例）。
与无基础疾病的成年人相比，所有年龄段有基础疾病的成年人发生PP和IPD的风险更高。这种风险随着基础疾病数量的增加而增加。我们的结果支持将肺炎球菌疫苗接种扩展至有基础疾病的年轻成年人，尤其是50 - 64岁的人群。
