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Seasonality, risk-factors and burden of community-acquired pneumonia in COPD patients: A population database study using linked healthcare records

Seasonality, risk-factors and burden of community-acquired pneumonia in COPD patients: A population database study using linked healthcare records
Seasonality, risk-factors and burden of community-acquired pneumonia in COPD patients: A population database study using linked healthcare records
Community acquired pneumonia (CAP) is more common in patients with chronic obstructive pulmonary disease (COPD) than in the adult general population, with studies of hospitalised CAP consistently reporting COPD as a frequent comorbidity. However, despite an increasing recognition of its importance, large studies evaluating the incidence patterns over time, risk-factors and burden of CAP in COPD are currently lacking.

A retrospective observational study using a large UK-based database of linked primary and secondary care records was conducted. Patients with a diagnosis of COPD aged ?40 years were followed for 5 years from the 1st January 2010. CAP and exacerbation episodes were identified from hospital discharge data and primary care coding records, and rates were calculated per month, adjusting for mortality, and displayed over time. In addition, baseline factors predicting future risk of CAP and hospital admission at CAP, were identified.

14513 COPD patients were identified: 13.4% (n=1938) had ?1 CAP episode, of whom 18.8% suffered from recurrent (?2) CAP. Highest rates of both CAP and exacerbations were seen in winter. A greater proportion of frequent, compared to infrequent exacerbators experienced recurrent CAP (5.1% versus 2.0% respectively, p<0.001) 75.6% of CAP episodes were associated with hospital admission compared to 22.1% of exacerbations. Older age and increasing grade of airflow limitation were independently associated with increased odds of CAP and hospital admission at CAP. Other independent predictors of future CAP included lower body mass index, inhaled-corticosteroid use, prior frequent exacerbations and comorbidities including ischaemic heart disease and diabetes.

CAP in COPD demonstrates clear seasonal patterns, with patient characteristics predictive of the odds of future CAP and hospital admission at CAP. Highlighting this burden of COPD-associated CAP during the winter period, informs us of the likely triggers and the need for more effective preventive strategies.
1178-2005
313-322
Williams, Nicholas P
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Coombs, Ngaire A
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Johnson, Matthew
bbafbaf0-dd02-4348-a2e5-8042ff22d0ed
Josephs, Lynn
b158666e-579d-4404-be7a-38d14f2713bb
Rigge, Lucy
549478f7-ac05-4164-8150-f657c88e7110
Staples, Karl J.
e0e9d80f-0aed-435f-bd75-0c8818491fee
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wilkinson, Tom M A
8c55ebbb-e547-445c-95a1-c8bed02dd652
Williams, Nicholas P
00ee9f78-fdc9-434f-be3e-5ded7a8abe08
Coombs, Ngaire A
e61ac0b6-59c7-47ed-9d8a-1b439f91e17a
Johnson, Matthew
bbafbaf0-dd02-4348-a2e5-8042ff22d0ed
Josephs, Lynn
b158666e-579d-4404-be7a-38d14f2713bb
Rigge, Lucy
549478f7-ac05-4164-8150-f657c88e7110
Staples, Karl J.
e0e9d80f-0aed-435f-bd75-0c8818491fee
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wilkinson, Tom M A
8c55ebbb-e547-445c-95a1-c8bed02dd652

Williams, Nicholas P, Coombs, Ngaire A, Johnson, Matthew, Josephs, Lynn, Rigge, Lucy, Staples, Karl J., Thomas, Mike and Wilkinson, Tom M A (2017) Seasonality, risk-factors and burden of community-acquired pneumonia in COPD patients: A population database study using linked healthcare records. International Journal of Chronic Obstructive Pulmonary Disease, 2017 (12), 313-322. (doi:10.2147/COPD.S121389).

Record type: Article

Abstract

Community acquired pneumonia (CAP) is more common in patients with chronic obstructive pulmonary disease (COPD) than in the adult general population, with studies of hospitalised CAP consistently reporting COPD as a frequent comorbidity. However, despite an increasing recognition of its importance, large studies evaluating the incidence patterns over time, risk-factors and burden of CAP in COPD are currently lacking.

A retrospective observational study using a large UK-based database of linked primary and secondary care records was conducted. Patients with a diagnosis of COPD aged ?40 years were followed for 5 years from the 1st January 2010. CAP and exacerbation episodes were identified from hospital discharge data and primary care coding records, and rates were calculated per month, adjusting for mortality, and displayed over time. In addition, baseline factors predicting future risk of CAP and hospital admission at CAP, were identified.

14513 COPD patients were identified: 13.4% (n=1938) had ?1 CAP episode, of whom 18.8% suffered from recurrent (?2) CAP. Highest rates of both CAP and exacerbations were seen in winter. A greater proportion of frequent, compared to infrequent exacerbators experienced recurrent CAP (5.1% versus 2.0% respectively, p<0.001) 75.6% of CAP episodes were associated with hospital admission compared to 22.1% of exacerbations. Older age and increasing grade of airflow limitation were independently associated with increased odds of CAP and hospital admission at CAP. Other independent predictors of future CAP included lower body mass index, inhaled-corticosteroid use, prior frequent exacerbations and comorbidities including ischaemic heart disease and diabetes.

CAP in COPD demonstrates clear seasonal patterns, with patient characteristics predictive of the odds of future CAP and hospital admission at CAP. Highlighting this burden of COPD-associated CAP during the winter period, informs us of the likely triggers and the need for more effective preventive strategies.

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More information

Accepted/In Press date: 21 November 2016
e-pub ahead of print date: 17 January 2017
Organisations: NIHR Southampton Respiratory Biomedical Research Unit, Primary Care & Population Sciences, Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 403325
URI: https://eprints.soton.ac.uk/id/eprint/403325
ISSN: 1178-2005
PURE UUID: 617d271f-ae44-4666-b8ca-39cb4e9666e1
ORCID for Karl J. Staples: ORCID iD orcid.org/0000-0003-3844-6457

Catalogue record

Date deposited: 29 Nov 2016 15:41
Last modified: 03 Dec 2019 01:46

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Contributors

Author: Nicholas P Williams
Author: Ngaire A Coombs
Author: Matthew Johnson
Author: Lynn Josephs
Author: Lucy Rigge
Author: Karl J. Staples ORCID iD
Author: Mike Thomas

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