Mohanty Salini, Johansson Kostenniemi Urban, Silfverdal Sven Arne, Salomonsson Stina, Iovino Federico, Bencina Goran, Tsoumani Eleana, Bruze Gustaf
Outcomes Research, Merck & Co, Inc, Rahway, New Jersey.
Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
JAMA Netw Open. 2024 Dec 2;7(12):e2445497. doi: 10.1001/jamanetworkopen.2024.45497.
A diagnosis of bacterial meningitis in childhood can lead to permanent neurological disabilities. Few studies have examined long-term consequences for work ability in adulthood.
To compare earnings, work loss, and educational attainment between adults diagnosed with bacterial meningitis in childhood and population comparators.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide registry-based matched cohort study included individuals in Sweden diagnosed with bacterial meningitis in childhood (aged <18 years) from January 1, 1987, to December 31, 2019, and general population comparators matched 1:9 on age, sex, and place of residence. Follow-up was completed December 31, 2020. Data were analyzed from February 7 to September 12, 2023.
A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register.
Annual taxable earnings (in 2020 US dollars), work loss (sum of sick leave and disability insurance), and educational attainment.
The cohort included 2534 individuals diagnosed with bacterial meningitis in childhood (mean [SD] age at diagnosis, 4.7 [5.3] years) and 22 806 comparators (13 510 [53.3%] male). Among those with childhood bacterial meningitis, 812 (32.0%) were diagnosed at younger than 1 year and 1351 (53.3%) were male. From 18 to 34 years of age, those with childhood meningitis had lower adjusted earnings relative to comparators and higher adjusted work loss. When pooling observations for individuals 28 years or older, the annual mean reduction in earnings was -$1295 (95% CI, -$2587 to -$4), representing a 4.0% (95% CI, 0%-8.0%) reduction relative to comparators, and the annual increase in work loss was 13.5 (95% CI, 8.6-18.5) days. There was a larger reduction in earnings for those with childhood meningitis relative to comparators with pneumococcal (Streptococcus pneumoniae) vs meningococcal (Neisseria meningitidis) meningitis. For work loss, there was a difference among all 3 major causes of meningitis, with the largest increase for pneumococcal meningitis. Individuals diagnosed at a younger age (below the median) had lower earnings relative to comparators and higher work loss than individuals diagnosed at an older age (above the median). Fewer individuals with childhood meningitis relative to comparators had obtained a high school degree at age 30 years (adjusted odds ratio, 0.68 [95% CI, 0.56-0.81]).
In this cohort study of adults diagnosed with bacterial meningitis in childhood, findings suggest that work ability decreases relative to population comparators, with lower earnings and higher work loss, especially among adults diagnosed with pneumococcal meningitis or diagnosed at a young age, with long-lasting costs for the individual patient and society at large.
儿童期细菌性脑膜炎的诊断可能导致永久性神经残疾。很少有研究探讨其对成年后工作能力的长期影响。
比较儿童期被诊断为细菌性脑膜炎的成年人与总体对照人群在收入、工作损失和教育程度方面的差异。
设计、设置和参与者：这项基于全国登记处的匹配队列研究纳入了1987年1月1日至2019年12月31日期间在瑞典儿童期（年龄<18岁）被诊断为细菌性脑膜炎的个体，以及在年龄、性别和居住地点方面按1:9匹配的总体对照人群。随访于2020年12月31日完成。数据于2023年2月7日至9月12日进行分析。
国家患者登记处记录的儿童期细菌性脑膜炎诊断。
年度应纳税收入（以2020年美元计）、工作损失（病假和残疾保险总和）和教育程度。
该队列包括2534名儿童期被诊断为细菌性脑膜炎的个体（诊断时的平均[标准差]年龄为4.7[5.3]岁）和22806名对照者（13510名[53.3%]为男性）。在儿童期细菌性脑膜炎患者中，812名（32.0%）在1岁之前被诊断，1351名（53.3%）为男性。在18至34岁之间，儿童期患脑膜炎的个体相对于对照者调整后的收入较低，调整后的工作损失较高。当汇总28岁及以上个体的观察结果时，年收入平均减少1295美元（95%置信区间，-2587美元至-4美元），相对于对照者减少了4.0%（95%置信区间，0%-8.0%），工作损失的年度增加为13.5天（95%置信区间，8.6-18.5天）。与肺炎球菌（肺炎链球菌）性脑膜炎或脑膜炎球菌（脑膜炎奈瑟菌）性脑膜炎的对照者相比，儿童期患脑膜炎的个体收入减少幅度更大。对于工作损失，三种主要脑膜炎病因之间存在差异，肺炎球菌性脑膜炎的增加幅度最大。诊断年龄较小（低于中位数）的个体相对于对照者收入较低，工作损失高于诊断年龄较大（高于中位数）的个体。与对照者相比，儿童期患脑膜炎的个体在30岁时获得高中文凭的人数较少（调整后的优势比为0.68[95%置信区间，0.56-0.81]）。
在这项对儿童期被诊断为细菌性脑膜炎的成年人的队列研究中，结果表明相对于总体对照人群，工作能力下降，收入较低且工作损失较高，尤其是在被诊断为肺炎球菌性脑膜炎或诊断年龄较小的成年人中，这对个体患者和整个社会都有长期成本。
