英国成人常见免疫介导炎症疾病患者接种肺炎球菌疫苗的效果:病例对照研究。

IF 15 1区 医学 Q1 RHEUMATOLOGY Lancet Rheumatology Pub Date : 2024-07-24 DOI:10.1016/S2665-9913(24)00128-0
Georgina Nakafero PhD , Matthew J Grainge PhD , Tim Card PhD , Prof Christian D Mallen PhD , Prof Jonathan S Nguyen Van-Tam MD , Prof Abhishek Abhishek PhD
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引用次数: 0

摘要

背景:免疫介导的炎症性疾病患者罹患肺炎球菌肺炎的风险较高。免疫介导的炎症性疾病患者接种肺炎球菌疫苗的效果尚未得到评估。我们研究了肺炎球菌疫苗接种对预防免疫介导的炎症性疾病患者肺炎相关发病率和死亡率的有效性:在这项匹配病例对照研究中,我们使用了英国临床实践研究数据链金牌数据库(Clinical Practice Research Datalink Gold database)中的初级保健电子健康记录数据以及相关住院和死亡数据。研究人员对1997年4月1日至2019年12月31日期间确诊患有常见免疫介导炎症性疾病的成年人进行了随访,随访时间从首次确诊日期开始,直至出现结果或最后一次随访日期。病例(即出现相关结果的病例)通过发病密度抽样与最多十名同期对照者进行年龄和性别匹配。结果包括因肺炎住院、因肺炎死亡或因下呼吸道感染需要使用抗生素而接受初级保健咨询。我们使用出院诊断来定义肺炎入院,使用死亡证明数据来定义肺炎死亡,如果初级保健咨询和抗生素处方发生在同一天,则定义为出现下呼吸道感染。我们采用了多变量、无条件的逻辑回归方法,并构建了三个模型来研究肺炎球菌疫苗接种作为一种暴露与三种结果中每一种结果之间的关联:第一项巢式病例对照分析包括 12 360 名患者(7326 名[59-3%]女性和 5034 名[40-7%]男性):其中1884人(15-2%)因肺炎住院,10476人(84-8%)未因肺炎住院。第二项分析包括 5321 名患者(3112 名[58-5%]女性和 2209 名[41-5%]男性):其中,781 人(14-7%)因肺炎死亡,4540 人(85-3%)在发病当日存活。第三项分析包括 54 530 名患者(女性 33 605 人[61-6%],男性 20 925 人[38-4%]):其中 10 549 人(19-3%)患有下呼吸道感染,接受过抗生素治疗,43 981 人(80-7%)未感染。在多变量分析中,肺炎球菌疫苗接种与肺炎住院(调整后的几率比为 0-70 [95% CI 0-60-0-81])、肺炎死亡(0-60 [0-48-0-76])和接受抗生素治疗的下呼吸道感染(0-76 [0-72-0-80])呈负相关:肺炎球菌疫苗接种可防止免疫介导的炎症性疾病患者因肺炎住院和死亡,且无明显的残余混杂因素。然而,在观察性研究(包括嵌套病例对照研究)中,无法完全排除残留的未测量混杂因素。鉴于本研究使用的是英国的数据,这些发现还应与其他国家的数据相互印证:国家健康与护理研究所。
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Effectiveness of pneumococcal vaccination in adults with common immune-mediated inflammatory diseases in the UK: a case–control study

Background

People with immune-mediated inflammatory disease are at increased risk of pneumococcal pneumonia. The effectiveness of pneumococcal vaccination in people with immune-mediated inflammatory diseases has not been evaluated. We investigated the effectiveness of pneumococcal vaccination in preventing morbidity and mortality associated with pneumonia in patients with immune-mediated inflammatory diseases.

Methods

In this matched case–control study, we used primary-care electronic health record data from the Clinical Practice Research Datalink Gold database in the UK, with linked hospitalisation and mortality data. Adults with incident common immune-mediated inflammatory diseases diagnosed between April 1, 1997, and Dec 31, 2019, were followed up from the first diagnosis date to the occurrence of an outcome or date of last follow-up. Cases (ie, those with an outcome of interest) were age-matched and sex-matched to up to ten contemporaneous controls by use of incidence density sampling. Outcomes were hospitalisation due to pneumonia, death due to pneumonia, or primary-care consultation for lower respiratory tract infection requiring antibiotics. We defined hospital admission for pneumonia using hospital discharge diagnoses, death due to pneumonia using death certification data, and lower respiratory tract infection as present when primary-care consultation and antibiotic prescription occurred on the same date. We used multivariable, unconditional, logistical regression and constructed three models to examine the association between pneumococcal vaccination as an exposure and each of the three outcomes.

Findings

The first nested case–control analysis included 12 360 patients (7326 [59·3%] women and 5034 [40·7%] men): 1884 (15·2%) who were hospitalised due to pneumonia and 10 476 (84·8%) who were not admitted to hospital due to pneumonia. The second analysis included 5321 patients (3112 [58·5%] women and 2209 [41·5%] men): 781 (14·7%) who died due to pneumonia and 4540 (85·3%) who were alive on the index date. The third analysis included 54 530 patients (33 605 [61·6%] women and 20 925 [38·4%] men): 10 549 (19·3%) with lower respiratory tract infection treated with antibiotics and 43 981 (80·7%) without infection. In the multivariable analysis, pneumococcal vaccination was negatively associated with hospitalisation due to pneumonia (adjusted odds ratio 0·70 [95% CI 0·60–0·81]), death due to pneumonia (0·60 [0·48–0·76]), and lower respiratory tract infection treated with antibiotics (0·76 [0·72–0·80]).

Interpretation

Pneumococcal vaccination is associated with protection against hospitalisation and death due to pneumonia in patients with immune-mediated inflammatory diseases, without apparent residual confounding. However, residual unmeasured confounding cannot be fully excluded in observational research, which includes nested case–control studies. These findings should also be corroborated with data from other countries, given that this study used UK-based data.

Funding

National Institute for Health and Care Research.

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来源期刊
Lancet Rheumatology
Lancet Rheumatology RHEUMATOLOGY-
CiteScore
34.70
自引率
3.10%
发文量
279
期刊介绍: The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials. With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.
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