title: Influence of chronic illnesses and underlying risk conditions on the incidence of pneumococcal pneumonia in older adults.
abstract: OBJECTIVE
  To investigate hospitalizations from pneumococcal pneumonia in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing pneumonia.
  
  
  METHODS
  Population-based cohort study involving 27,204 individuals ≥ 60 years old in Southern Catalonia, Spain. All cases of hospitalization from pneumococcal pneumonia (bacteremic and nonbacteremic) were collected since 01/12/2008 until 30/11/2011. Cox regression was used to calculate hazards ratio (HR) and estimate the association between baseline conditions and the risk of developing pneumococcal pneumonia.
  
  
  RESULTS
  Maximum incidences (per 1000 person-years) appeared among patients with history of prior pneumonia (14.6), nursing home residents (12.8), persons with immunodeficiency/asplenia (7.7) and patients with chronic pulmonary disease (7.6). In multivariable analysis, age (HR: 1.05), nursing home residence (HR: 4.59), history of prior pneumonia (HR: 3.58), stroke (HR: 2.50), chronic heart disease (HR: 1.53), chronic pulmonary disease (HR: 4.09), diabetes mellitus (HR: 1.66), smoking (HR: 1.69) and immunosuppressive medication (HR: 1.87) appeared significantly associated with an increased risk of pneumococcal pneumonia.
  
  
  CONCLUSIONS
  Our data support that nursing home residence, chronic pulmonary disease and immunocompromising conditions are the underlying conditions most strongly associated with an increasing risk of pneumococcal pneumonia in older adults. This data underline the need for better prevention strategies among these persons.
authors.affiliation: Primary Care Service of Camp de Tarragona, Institut Catala de la Salut, Rambla Nova 124, D, 1ºA, 43001, Tarragona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Vila-Corcoles
authors.affiliation: Primary Care Service of Camp de Tarragona, Institut Catala de la Salut, Rambla Nova 124, D, 1ºA, 43001, Tarragona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguirre-Chavarria
authors.affiliation: Primary Care Service of Camp de Tarragona, Institut Catala de la Salut, Rambla Nova 124, D, 1ºA, 43001, Tarragona, Spain. oochoa.tarte.ics@gencat.cat.
authors.forename: Olga
authors.initials: O
authors.lastname: Ochoa-Gondar
authors.affiliation: Primary Care Service of Camp de Tarragona, Institut Catala de la Salut, Rambla Nova 124, D, 1ºA, 43001, Tarragona, Spain.
authors.forename: Cinta
authors.initials: C
authors.lastname: de Diego
authors.affiliation: Primary Care Research Institute (IDIAP Jordi Gol) and Research Associate, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.affiliation: Joan XXIII Hospital, Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain.
authors.forename: Frederic
authors.initials: F
authors.lastname: Gomez
authors.affiliation: Santa Tecla Hospital, Rambla Vella, 14, 43003, Tarragona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Raga
authors.affiliation: Santa Tecla Hospital, Rambla Vella, 14, 43003, Tarragona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Barnes
authors.affiliation: Joan XXIII Hospital, Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Magarolas
authors.affiliation: Joan XXIII Hospital, Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Esteban
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Incidence; Pneumococcal pneumonia; Risk factors; Streptococcus pneumoniae