The management of patients with community-acquired pneumonia beyond antibiotic therapy

Does marriage protect against hospitalization with pneumonia? A population-based case-control study

BACKGROUND

To reduce the increasing burden of pneumonia hospitalizations, we need to understand their determinants. Being married may decrease the risk of severe infections, due to better social support and healthier lifestyle.

PATIENTS AND METHODS

In this population-based case-control study, we identified all adult patients with a first-time pneumonia-related hospitalization between 1994 and 2008 in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We performed conditional logistic regression analysis to estimate the odds ratios (ORs) for pneumonia hospitalization among persons who were divorced, widowed, or never married, as compared with married persons, adjusting for age, sex, 19 different comorbidities, alcoholism-related conditions, immunosuppressant use, urbanization, and living with small children.

RESULTS

The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 matched population controls. Compared with controls, the pneumonia patients were more likely to be divorced (10% versus 7%) or never married (13% versus 11%). Divorced and never-married patients were much more likely to have previous diagnoses of alcoholism-related conditions (18% and 11%, respectively) compared with married (3%) and widowed (6%) patients. The adjusted OR for pneumonia-related hospitalization was increased, at 1.29 (95% confidence interval [CI]: 1.25-1.33) among divorced; 1.15 (95% CI: 1.12-1.17) among widowed; and 1.33 (95% CI: 1.29-1.37) among never-married individuals as compared with those who were married.

CONCLUSION

Married individuals have a decreased risk of being hospitalized with pneumonia compared with never-married, divorced, and widowed patients.

Chronic heart failure and risk of hospitalization with pneumonia: a population-based study

BACKGROUND

Chronic heart failure may increase risk of pneumonia due to alveoli flooding and reduced microbial clearance. We examined whether chronic heart failure is a risk factor for pneumonia-related hospitalization.

METHODS

In this large population-based case-control study we identified adult patients with a first-time primary or secondary discharge diagnosis of viral or bacterial pneumonia between 1994 and 2008, using health care databases in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We used conditional logistic regression to compute relative risk (RR) for pneumonia-related hospitalization among persons with and without pre-existing heart failure, overall and stratified by medical treatment. We controlled for a wide range of comorbidities, socioeconomic markers and immunosuppressive treatment.

RESULTS

The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 population controls. The adjusted OR for pneumonia-related hospitalization among persons with previous heart failure was 1.81 (95% confidence interval (CI): 1.76-1.86) compared with other individuals. The adjusted pneumonia RR was lower for heart failure patients treated with thiazides only (adjusted OR=1.56, 95% CI: 1.46-1.67), as compared with patients whose treatment included loop-diuretics and digoxin as a marker of increased severity (adjusted OR=1.95, 95% CI: 1.85-2.06) or both loop-diuretics and spironolactone (adjusted OR=2.02, 95% CI: 1.90-2.15). The population-attributable risk of pneumonia hospitalizations caused by heart failure in our population was 6.2%.

CONCLUSIONS

Patients with chronic heart failure, in particular those using loop diuretics, have markedly increased risk of hospitalization with pneumonia.