title: Rates of pneumonia among children and adults with chronic medical conditions in Germany.
abstract: BACKGROUND
  The objective of this study is to evaluate rates of all-cause pneumonia among "at-risk" and "high-risk" children and adults in Germany-in comparison with age-stratified healthy counterparts-during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine.
  
  
  METHODS
  Retrospective cohort design and healthcare claims information for 3.4 M persons in Germany (2009-2012) were employed. Study population was stratified by age and risk profile (healthy, "at-risk" [with chronic medical conditions], and "high-risk" [immunocompromised]). At-risk and high-risk conditions, as well as episodes of all-cause pneumonia, were identified via diagnosis, procedure, and drug codes.
  
  
  CONCLUSIONS
  Rates of all-cause pneumonia were 1.7 (95 % CI 1.7-1.8) to 2.5 (2.4-2.5) times higher among children and adults with at-risk conditions versus healthy counterparts, and 1.8 (1.8-1.9) to 4.1 (4.0-4.2) times higher among children and adults with high-risk conditions. Rates of all-cause pneumonia among at-risk persons increased in a graded and monotonic fashion with increasing numbers of conditions (i.e., risk stacking).
  
  
  CONCLUSIONS
  An increased risk for all-cause pneumonia in German children and adults with a spectrum of medical conditions persists in the era of widespread pneumococcal vaccination, and pneumonia risk in persons with ≥2 at-risk conditions is comparable or higher than those with high-risk conditions.
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. spelton@bu.edu.|Boston Medical Center, Boston, MA, USA. spelton@bu.edu.|Maxwell Finland Laboratory for Infectious Diseases, 670 Albany Street, 6th Floor, Boston, MA, 02118, USA. spelton@bu.edu.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Pelton
authors.affiliation: Boston University School of Public Health, Boston, MA, USA. kimshea@bu.edu.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Shea
authors.affiliation: Pfizer Inc., Collegeville, PA, USA. rfarkouh@pfizer.com.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Farkouh
authors.affiliation: Pfizer Inc., Collegeville, PA, USA. dstrutto@jhsph.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Strutton
authors.affiliation: Xcenda GmbH, Hannover, Germany. sebastian.braun@xcenda.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Braun
authors.affiliation: Xcenda GmbH, Hannover, Germany. christian.jacob@xcenda.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacob
authors.affiliation: Pfizer bv, Capelle a/d IJssel, Netherlands. rogier.klok@pfizer.com.
authors.forename: Rogier
authors.initials: R
authors.lastname: Klok
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA, USA. egruen@pai2.com.
authors.forename: Elana S
authors.initials: ES
authors.lastname: Gruen
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA, USA. dweycker@pai2.com.
authors.forename: Derek
authors.initials: D
authors.lastname: Weycker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology; D011014:Pneumonia / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D012189:Retrospective Studies; D012306:Risk; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000276:immunology; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate