title: Hypoalbuminemia, influenza vaccination and other factors related to the development of pneumonia acquired outside hospitals in southern Japan: A case-control study.
abstract: OBJECTIVE
  Pneumonia is the third largest cause of death in Japan. Pneumonia continues to be one of the most common causes of morbidity, hospitalization and mortality, especially in the elderly. The aim of the present study was to evaluate the factors related to the development of pneumonia acquired outside hospitals among the Japanese elderly.
  
  
  METHODS
  We carried out a hospital-based, case-control study. Cases were patients who had been newly diagnosed with pneumonia acquired outside hospitals. For each case, one to three controls were defined as outpatients with other diseases (not pneumonia) at the same hospitals. All participants (i.e. 50 cases and 110 controls) were aged 65 years and older.
  
  
  RESULTS
  Compared with control participants, hypoalbuminemia (<3.5 g/dL) and low body mass index (<18.0) were more common in pneumonia patients, whereas the proportion of those who could go out by themselves (i.e. self-support in activities of daily living) and the vaccination rate of seasonal influenza were lower in patients with pneumonia than control participants. Even after controlling for age, sex, hospital and aforementioned four factors, hypoalbuminemia (OR 9.19, 95% CI 3.70-22.81) increased the risk of pneumonia, whereas seasonal influenza vaccination (OR 0.37, 95% CI 0.16-0.85) reduced the risk. Even after excluding those who lived in a nursing home, hypoalbuminemina (OR 12.19, 95% CI 4.29-34.63) increased the risk of pneumonia.
  
  
  CONCLUSIONS
  Hypoalbuminemia might be a risk factor for pneumonia among the elderly living in the community.
authors: Department of Community Health and Clinical Epidemiology, St. Mary's College, Kurume, Japan.|St.Mary's Hospital, Kurume, Japan.
authors: Masakazu
authors: M
authors: Washio
authors: Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan.
authors: Kyoko
authors: K
authors: Kondo
authors: St.Mary's Hospital, Kurume, Japan.
authors: Nobumitsu
authors: N
authors: Fujisawa
authors: St.Mary's Hospital, Kurume, Japan.
authors: Eiji
authors: E
authors: Harada
authors: St.Mary's Hospital, Kurume, Japan.
authors: Hideki
authors: H
authors: Tashiro
authors: St.Mary's Hospital, Kurume, Japan.
authors: Tetsuya
authors: T
authors: Mizokami
authors: National Hospital Organization Fukuoka Hospital, Fukuoka, Japan.
authors: Hiroko
authors: H
authors: Nogami
authors: National Hospital Organization Fukuoka Hospital, Fukuoka, Japan.
authors: Tomoaki
authors: T
authors: Iwanaga
authors: School of Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Yoichi
authors: Y
authors: Nakanishi
authors: Nagoya Chikusa Public Health Center, Nagoya, Japan.
authors: Kanzo
authors: K
authors: Suzuki
authors: Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan.
authors: Satoko
authors: S
authors: Ohfuji
authors: Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan.
authors: Wakaba
authors: W
authors: Fukushima
authors: Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan.
authors: Yoshio
authors: Y
authors: Hirota
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D007251:Influenza, Human / Q000209:etiology* / Q000517:prevention & control*; D007564:Japan; D008297:Male; D022242:Pneumococcal Vaccines; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000517:prevention & control*; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines
keywords: community-acquired pneumonia; elderly people; hypoalbuminemia; influenza vaccine; risk factor