454. Bad Habits Associated with Younger Age in Older Adults with Pneumococcal Disease
Session: Poster Abstract Session: Pneumococcal Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Aspire Poster - FINAL.pdf (902.8 kB)
  • Background: Disease caused by Streptococcus pneumoniae (pneumococcus) is the leading cause of infectious morbidity and mortality in older adults in the United States. The epidemiology of pneumococcal disease (PD) in adults 65 years and older is better known than in adults aged 50-64. The objective of this study was to investigate differences in pneumococcal risk factors, outcomes, and burden of disease between these age groups.

    Methods: A retrospective cohort was conducted including all inpatients 50 years and older with laboratory-confirmed PD from a large Midwest academic hospital between January 1, 2002 and November 30, 2012.  Demographic, risk factor and outcomes data were collected through manual medical chart reviews and informatics queries. Univariate and multivariate analyses were conducted to compare variables between age groups.

    Results: 673 inpatients age ≥50 with PD were identified; 388 (58%) were in the 50-64 age group.  285 (42%) had invasive PD (IPD), 112 (17%) died within 30 days, and 113 (17%) were readmitted within 30 days.  Mortality (13% vs. 21%, Odds Ratio (OR) = 0.58, {95% confidence interval (CI) 0.39-0.87)} and ICU admission (42% vs. 51%, OR = 0.69 {CI 0.50-0.92} were lower in the 50-64 group, compared to the ≥65 group.  Active alcohol use (43% vs 24%, OR=2.3 {CI 1.6-3.2}, smoking (47% vs. 25%, OR = 2.4 {CI 1.7-3.4}, and illicit drug use (19% vs. 3%, OR 6.8 {CI 3.3-13.9}) were more prevalent in the 50-64 group.  These activities remained significant on multivariate logistic regression analysis (adjusted ORs= 1.7, 1.8, and 5.0, for alcohol use, smoking, and illicit drug use, respectively). IPD, readmission and need for mechanical ventilation were not associated with age group, however readmission (21% vs. 14%, OR=1.6 {CI 1.1-2.4}) and need for mechanical ventilation (23% vs. 53%, OR= 0.27 {0.19-0.37}) were associated with IPD, compared to non-IPD.

    Conclusion: Adverse lifestyle habits may be associated with younger age in older adults with PD.  As pneumococcal vaccine recommendations for adults evolve, lifestyle modification may be another important factor to consider for PD prevention.  Further studies on the magnitude of impact of these lifestyle habits as risk factors for PD are warranted. 

    Nisha Santhanam, MPH and Steven Lawrence, MD, MSc, Washington University School of Medicine, St. Louis, MO


    N. Santhanam, None

    S. Lawrence, Merck: Consultant, Consulting fee
    Pfizer: Grant Investigator, Grant recipient

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