School of Public Health and Community Medicine, University of New South Wales,Sydney, NSW,Australia.
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead,NSW,Australia.
Epidemiol Infect. 2019 Jan;147:e118. doi: 10.1017/S0950268818003473.
Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65-84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060-1122) compared with 522/100 000 (95% CI 501-545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61-22.87) vs. 6.82/100 000 (95% CI 4.56-9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.
社区获得性肺炎（CAP）会导致大量老年人住院和死亡。已知存在与肺炎球菌病相关的生活方式和医疗风险因素，但在澳大利亚，其额外风险的严重程度尚未得到充分量化。我们利用新南威尔士州（45 岁及以上研究）中的一项大型基于人群的老年前瞻性队列研究，该研究与 2006 年至 2015 年期间的特定病因住院、疾病报告和死亡登记相关联。我们估计了 CAP 住院（ICD-10 J12-18）、侵袭性肺炎球菌病（IPD）报告和疑似非侵袭性肺炎球菌 CAP 住院（J13 + J18.1，不包括 IPD）的特定年龄发病率，将至少有一个风险因素的人与没有风险因素的人进行了比较。住院病死率（CFR）包括住院后 30 天内的死亡。在 266951 名随访 185 万个人年的参与者中，有 8747 人首次因 CAP 住院，157 人发生 IPD 报告，305 人发生非侵袭性肺炎球菌 CAP 住院。在 65-84 岁的人群中，54.7%至少有一个确定的风险因素，在年龄 ⩾85 岁的人群中增加到 57.0%。在至少有一个风险因素的 ⩾65 岁人群中，CAP 住院的发病率是没有风险因素人群的两倍，前者为 1091/100000（95%置信区间 [CI]1060-1122），后者为 522/100000（95%CI501-545），而在同等人群中，IPD 几乎高三倍（18.40/100000（95%CI14.61-22.87）比 6.82/100000（95%CI4.56-9.79））。CFR 随年龄增长而增加，但风险状况的差异有限，除了 45 至 64 岁的人群。至少有一个风险因素的 ⩾65 岁成年人 CAP 和 IPD 的发病率要高得多，这表明基于额外风险因素的疫苗接种策略可能具有成本效益。
