Risk of pneumonia and pneumococcal disease in people hospitalized with diabetes mellitus: English record-linkage studies

• Published in: Diabetic medicine Vol. 30; no. 12; pp. 1412 - 1419
• Main Authors: Seminog, O. O., Goldacre, M. J.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.12.2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Child; Child, Preschool; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - immunology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; England - epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Health Policy; Hospitalization - statistics & numerical data; Humans; Incidence; Infant; Infant, Newborn; Male; Medical Record Linkage; Medical sciences; Middle Aged; Patient Acceptance of Health Care; Pneumococcal Infections - epidemiology; Pneumococcal Infections - etiology; Pneumococcal Vaccines - administration & dosage; Pneumonia - epidemiology; Pneumonia - etiology; Retrospective Studies; Risk Factors; Sex Distribution; Streptococcus pneumoniae; Vaccination - utilization; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; England; United Kingdom > UK; Endocrinopathy; Medical data; Lung disease; Obesity; Pneumonia; Nutrition; Respiratory disease; Diabetes mellitus; Nutrition disorder; Metabolic diseases; Risk; Infection; English; Streptococcal infection; Risk factor; Bacteriosis; Medical record; Pneumococcal infection; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12260

Background The risk of invasive pneumococcal disease is higher in people with diabetes mellitus than those without. People with diabetes should be considered for routine pneumococcal immunization. This policy has been in place in England for more than a decade. We aimed to estimate, at the population level, the current scale of excess risk of pneumococcal disease in patients with diabetes, and whether the risks have decreased in recent years with the introduction of a pneumococcal vaccine. Methods We used two data sets of linked hospital admission and death records—the Oxford Record Linkage Study (1963–1998) and all‐England linked hospital episode statistics (1999–2011). As a measure of relative risk, we calculated the rate ratio of pneumococcal disease in cohorts of people hospitalized with diabetes compared with cohorts without a record of diabetes. Results The risk of pneumococcal disease in patients hospitalized with diabetes mellitus has declined a little, but it is still high. The all‐ages rate ratio in England declined from 1.92 (95% CI 1.89–1.94) in 1999–2002 to 1.68 (95% CI 1.65–1.71) in 2007–2011. In people aged under 60 years, rate ratios were higher and their decline was more substantial: rate ratios declined from 3.37 (95% CI 3.28–3.46) in 1999–2002 to 2.33 (95% CI 2.21–2.45) in 2007–2011. Conclusions Patients admitted to hospital with diabetes mellitus remain at increased risk of pneumococcal infection despite a national immunization policy. Possible explanations for the elevated risk include low vaccine uptake or low effectiveness of available vaccine. Clinicians should be aware of the risk of pneumococcal infection in people with diabetes. What's new? We used two very large data sets of electronic records, including an English national data set of linked hospital and mortality records, to study the risk of pneumonia and pneumococcal disease in people hospitalized with diabetes mellitus. Despite national policies to immunize people with diabetes against pneumococcal infection, invasive pneumococcal disease remains higher in people with diabetes than without. Among possible explanations for the increased risk are low uptake of pneumococcal vaccine in patients with diabetes or low effectiveness of the vaccine type used.