Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL, USA.
School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Med Sci. 2024 May;367(5):304-309. doi: 10.1016/j.amjms.2024.02.002. Epub 2024 Feb 9.
Streptococcus pneumoniae (Spn) infection remains common worldwide despite recent vaccine efforts. Invasive pneumococcal disease (IPD) is the most severe form of Spn infection. Known individual risk factors for IPD include male gender and African American race. However, area-level socioeconomic factors have not been assessed. We examined the association of neighborhood-level disadvantages and risk of IPD in a tertiary medical center located in a socioeconomic diverse urban area in the Southeastern United States.
Patients hospitalized with culture-confirmed Streptococcus pneumoniae (Spn) infection from 01/01/2010 - 12/31/2019 were identified from electronic health record (EHR). The cohort's demographic and clinical information were obtained from EHR. Patients' residential address was geocoded and matched to 2015 area deprivation index (ADI). The association of ADI and IPD was evaluated using logistic regression after controlling for the demographic information (age, sex, race) and clinical factors (BMI, smoking status, alcoholism, immunosuppressive status, vaccination status, comorbidities).
A total of 268 patients were hospitalized with culture-positive Streptococcus pneumoniae infection and 92 (34.3%) of them had IPD. The analysis showed that higher neighborhood deprivation (ADI in 79-100) was associated with increased risk of developing IPD in younger patients with age less than 65 (p = 0.007) after controlling for the individual demographic information and clinical factors.
ADI is a risk factor for IPD in younger adults. Community-level socioeconomic risk factors should be considered when developing prevention strategies such as increasing vaccine uptake in high risk population to reduce the disease burden of IPD.
尽管最近采取了疫苗措施，但肺炎链球菌（Spn）感染在全球仍然很常见。侵袭性肺炎球菌病（IPD）是 Spn 感染最严重的形式。已知 IPD 的个体危险因素包括男性和非裔美国人种族。然而，尚未评估地区级社会经济因素。我们在美国东南部一个社会经济多样化的城市的三级医疗中心，研究了邻里劣势与 IPD 风险之间的关联。
从电子健康记录（EHR）中确定了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间因培养确认的肺炎链球菌（Spn）感染住院的患者。该队列的人口统计学和临床信息从 EHR 中获得。患者的居住地址被地理编码并与 2015 年的区域剥夺指数（ADI）相匹配。在控制人口统计学信息（年龄、性别、种族）和临床因素（BMI、吸烟状况、酗酒、免疫抑制状态、疫苗接种状况、合并症）后，使用逻辑回归评估 ADI 与 IPD 的关联。
共有 268 名患者因培养阳性肺炎链球菌感染住院，其中 92 名（34.3%）患有 IPD。分析表明，在控制个体人口统计学信息和临床因素后，年龄小于 65 岁的年轻患者中，邻里贫困程度较高（ADI 在 79-100 之间）与发生 IPD 的风险增加相关（p = 0.007）。
ADI 是年轻成年人 IPD 的危险因素。在制定预防策略时，应考虑社区级社会经济风险因素，例如增加高危人群的疫苗接种率，以减轻 IPD 的疾病负担。
