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New evidence of risk factors for community-acquired pneumonia: a population-based study

¹ Critical Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Ciber Enfermedades Respiratorias (CiBERS), ² Dept of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, ³ Research Unit, Hospital de Mataró, Mataró, ⁵ Institut Català de la Salut (ICS), ⁸ Institut Clínic del Torax, Servei de Pneumologia, IDIBAPS, Hospital Clínic de Barcelona, Universitat de Barcelona, CiBERS, Barcelona, ⁶ Servei de Salut de les Illes Balears (IB-SALUT), Palma de Mallorca, ⁷ INSALUD, Valencia, Spain, ⁴ Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Principality of Andorra, ⁹ For the full list of the PACAP study group, please see the Acknowledgements section., ¹⁰ These authors contributed equally to this article.

CORRESPONDENCE: J. Almirall, Intensive Care Unit, Hospital de Mataró, Carretera de Cirera s/n, E-08304 Mataró, Barcelona, Spain. Fax: 34 937417770. E-mail: jalmirall{at}csdm.cat

Keywords: Community-acquired pneumonia, population-based study, risk factors

Received: July 27, 2007
Accepted January 9, 2008

The aim of the present study was to identify risk factors for community-acquired pneumonia (CAP), with special emphasis on modifiable risk factors and those applicable to the general population.

A population-based, case–control study was conducted, with a target population of 859,033 inhabitants aged >14 yrs. A total of 1,336 patients with confirmed CAP were matched to control subjects by age, sex and primary centre over 1 yr.

In the univariate analysis, outstanding risk factors were passive smoking in never-smokers aged >65 yrs, heavy alcohol intake, contact with pets, households with >10 people, contact with children, interventions on the upper airways and poor dental health. Risky treatments included amiodarone, N-acetylcysteine and oral steroids. Influenza and pneumococcal vaccine, and visiting the dentist were protective factors. Multivariable analysis confirmed cigarette smoking, usual contact with children, sudden changes of temperature at work, inhalation therapy (particularly containing steroids and using plastic pear-spacers), oxygen therapy, asthma and chronic bronchitis as independent risk factors.

Interventions for reducing community-acquired pneumonia should integrate health habits and lifestyle factors related to household, work and community, together with individual clinical conditions, comorbidities and oral or inhaled regular treatments. Prevention would include vaccination, dental hygiene and avoidance of upper respiratory colonisation.

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				M. P. Wise, D. W. Williams, M. A. Lewis, J. G. Thomas, and P. J. Frost Impact of poor dental health on pneumonia Eur. Respir. J., October 1, 2008; 32(4): 1123 - 1124. [Full Text] [PDF]