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Lee TA, Xu J, Weaver FM, Weiss KB. Risk of Pneumonia-Related Hospitalizations in Patients with Chronic Lung Disease. Poster session presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.
Objectives:Patients with chronic obstructive pulmonary disease (COPD) are included as a high-risk population in pneumococcal vaccination recommendations whereas asthma patients are not. There is little evidence to support including persons with asthma as a high-risk group. Therefore, the objective of this study was to evaluate the risk of pneumococcal pneumonia-related hospitalizations in patients with COPD or asthma and investigate vaccination impact.Methods:We identified veterans with asthma, COPD or combined asthma and COPD (CAC) in FY1997 and followed them through FY2002 using the VA NPCD. Patients were matched on age, gender and geographic region to controls. Sub-groups with documented pneumococcal vaccination during the follow-up period were identified. Pneumococcal pneumonia-related hospitalization rates in the follow-up period were determined. For vaccinated patients, hospitalization rates in pre-vaccination and post-vaccination periods were calculated. We determined pneumonia-related hospitalization risk in disease groups compared to controls using negative binomial models to control for differences between groups.Results:We identified 113,880 patients with COPD (95,556), asthma (12,115) and CAC (6209) and equal controls. Pneumococcal pneumonia hospitalization rates were: COPD = 0.53 per 100 patient years; asthma = 0.06; and CAC = 0.35. The adjusted risk of pneumococcal pneumonia hospitalization compared to controls was: COPD = 3.39 (95% CI, 2.98-3.85); asthma = 1.07 (0.61-11.89); and CAC = 1.82 (1.11-3.01). Following vaccination, the number of events decreased in COPD and asthma groups and controls. In the vaccinated sub-groups, the adjusted risk for hospitalizations in COPD patients relative to controls was 8.02 (4.44-14.48) pre-vaccination and 3.87 (2.55-5.88) post-vaccination. In the asthma patients, the adjusted risk was 0.76 (0.17-3.53) pre-vaccination and 0.30 (0.04-1.99) post-vaccination.Implications:Pneumococcal vaccination appears to reduce the risk of pneumonia-related hospitalizations in patients with COPD; however they still had an increased risk compared to similar patients without COPD. Asthma patients had hospitalization rates, both before and after vaccination, comparable to similar patients without asthma.Impacts:Pneumococcal vaccination is effective in reducing pneumococcal pneumonia-related hospitalizations in COPD patients. The vaccination also reduces events in asthma patients, but rates are similar to non-asthma patients; therefore the overall value of vaccinating this group should be further studied.