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The risk of community-acquired pneumonia among 9803 patients with coeliac disease compared to the general population: a cohort study

Zingone, Fabiana; Abdul Sultan, Alyshah; Crooks, Colin J.; Tata, Laila J.; Ciacci, Carolina; West, Joe

Authors

Fabiana Zingone

Alyshah Abdul Sultan

Carolina Ciacci

JOE WEST JOE.WEST@NOTTINGHAM.AC.UK
Professor of Epidemiology



Abstract

Background: Patients with coeliac disease are considered as individuals for whom pneumococcal vaccination is advocated.

Aim: To quantify the risk of community-acquired pneumonia among patients with coeliac disease, assessing whether vaccination against streptococcal pneumonia modified this risk.

Methods: We identified all patients with coeliac disease within the Clinical Practice Research Datalink linked with English Hospital Episodes Statistics between April 1997 and March 2011 and up to 10 controls per patient with coeliac disease frequency matched in 10-year age bands. Absolute rates of community-acquired pneumonia were calculated for patients with coeliac disease compared to controls stratified by vaccination status and time of diagnosis using Cox regression in terms of adjusted hazard ratios (HR).

Results: Among 9803 patients with coeliac disease and 101 755 controls, respectively, there were 179 and 1864 first community-acquired pneumonia events. Overall absolute rate of pneumonia was similar in patients with coeliac disease and controls: 3.42 and 3.12 per 1000 person-years respectively (HR 1.07, 95% CI 0.91–1.24). However, we found a 28% increased risk of pneumonia in coeliac disease unvaccinated subjects compared to unvaccinated controls (HR 1.28, 95% CI 1.02–1.60). This increased risk was limited to those younger than 65, was highest around the time of diagnosis and was maintained for more than 5 years after diagnosis. Only 26.6% underwent vaccination after their coeliac disease diagnosis.

Conclusions: Unvaccinated patients with coeliac disease under the age of 65 have an excess risk of community-acquired pneumonia that was not found in vaccinated patients with coeliac disease. As only a minority of patients with coeliac disease are being vaccinated there is a missed opportunity to intervene to protect these patients from pneumonia.

Citation

Zingone, F., Abdul Sultan, A., Crooks, C. J., Tata, L. J., Ciacci, C., & West, J. (in press). The risk of community-acquired pneumonia among 9803 patients with coeliac disease compared to the general population: a cohort study. Alimentary Pharmacology and Therapeutics, 44(1), https://doi.org/10.1111/apt.13652

Journal Article Type Article
Acceptance Date Apr 14, 2016
Online Publication Date May 5, 2016
Deposit Date Jun 10, 2016
Publicly Available Date Jun 10, 2016
Journal Alimentary Pharmacology and Therapeutics
Print ISSN 0269-2813
Electronic ISSN 1365-2036
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 44
Issue 1
DOI https://doi.org/10.1111/apt.13652
Keywords Pneumonia, Coeliac Disease, Vaccination, Pneumococcal Pneumonia
Public URL http://eprints.nottingham.ac.uk/id/eprint/33906
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/apt.13652/abstract
Related Public URLs http://dx.doi.org/10.1111/apt.13652
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information This is the peer reviewed version of the following article: Zingone, F., Abdul Sultan, A., Crooks, C. J., Tata, L. J., Ciacci, C. and West, J. (2016), The risk of community-acquired pneumonia among 9803 patients with coeliac disease compared to the general population: a cohort study. Alimentary Pharmacology & Therapeutics, 44: 57–67. doi: 10.1111/apt.13652 which has been published in final form at http://onlinelibrary.wi...111/apt.13652/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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