Risk of Community-acquired Pneumonia in Patients with a Diagnosis of Pernicious Anemia: a Population-based Retrospective Cohort Study

Overview

Journal Eur J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2015 Jul 31

PMID 26225868

Citations 3

Authors

Christopher V Almario

David C Metz

Kevin Haynes

Yu-Xiao Yang

Affiliations

Soon will be listed here.

Abstract

Objective: Pernicious anemia (PA) is an autoimmune disease that causes achlorhydria or profound hypochlorhydria. We conducted a population-based study to determine whether individuals with PA are at an increased risk for community-acquired pneumonia (CAP).

Methods: We performed a retrospective cohort study using The Health Improvement Network (THIN) from the UK (1993-2009). The eligible study cohort included individuals 18 years of age or older, with at least 1 year of THIN follow-up. The exposed group consisted of individuals with a diagnosis code for PA. The unexposed group consisted of individuals without a diagnosis of PA and was frequency matched with the exposed group with respect to age, sex, and practice site. Cox regression analysis was used to determine the hazard ratio with the 95% confidence interval for CAP associated with PA, accounting for a comprehensive list of potential confounders.

Results: The study included 13,605 individuals with PA and 50,586 non-PA individuals. The crude incidence rate of CAP was 9.4/1000 person-years for those with PA, versus 6.4/1000 person-years for those without PA. The multivariable adjusted hazard ratio for CAP associated with PA was 1.18 (95% confidence interval 1.08-1.29).

Conclusion: In this large population-based cohort study, individuals with PA and presumed chronic achlorhydria were at an increased risk for CAP.

Citing Articles

Risk factors for Pseudomonas aeruginosa colonization in non-cystic fibrosis bronchiectasis and clinical implications.

Kwok W, Man Ho J, Tam T, Ip M, Lam D Respir Res. 2021; 22(1):132.

PMID: 33910573 PMC: 8080398. DOI: 10.1186/s12931-021-01729-5.

Association between micronutrient deficiency and acute respiratory infections in healthy adults: a systematic review of observational studies.

Wang M, Koh J, Pang J Nutr J. 2019; 18(1):80.

PMID: 31785608 PMC: 6885309. DOI: 10.1186/s12937-019-0507-6.

Prediction of pneumonia hospitalization in adults using health checkup data.

Uematsu H, Yamashita K, Kunisawa S, Otsubo T, Imanaka Y PLoS One. 2017; 12(6):e0180159.

PMID: 28662167 PMC: 5491140. DOI: 10.1371/journal.pone.0180159.

References

Stockbruegger R, Cotton P, Menon G, BEILBY J, Bartholomew B, Hill M . Pernicious anaemia, intragastric bacterial overgrowth, and possible consequences. Scand J Gastroenterol. 1984; 19(3):355-64. View

Ogdie A, Alehashemi S, Love T, Jiang Y, Haynes K, Hennessy S . Validity of psoriatic arthritis and capture of disease modifying antirheumatic drugs in the health improvement network. Pharmacoepidemiol Drug Saf. 2014; 23(9):918-22. PMC: 4149813. DOI: 10.1002/pds.3677. View

Peghini P, Katz P, Bracy N, Castell D . Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors. Am J Gastroenterol. 1998; 93(5):763-7. DOI: 10.1111/j.1572-0241.1998.221_a.x. View

Hansell A, Hollowell J, Nichols T, McNiece R, Strachan D . Use of the General Practice Research Database (GPRD) for respiratory epidemiology: a comparison with the 4th Morbidity Survey in General Practice (MSGP4). Thorax. 1999; 54(5):413-9. PMC: 1763769. DOI: 10.1136/thx.54.5.413. View

Bourke A, Dattani H, Robinson M . Feasibility study and methodology to create a quality-evaluated database of primary care data. Inform Prim Care. 2004; 12(3):171-7. DOI: 10.14236/jhi.v12i3.124. View

Lewis J, Bilker W, Weinstein R, Strom B . The relationship between time since registration and measured incidence rates in the General Practice Research Database. Pharmacoepidemiol Drug Saf. 2005; 14(7):443-51. DOI: 10.1002/pds.1115. View

Lewis J, Schinnar R, Bilker W, Wang X, Strom B . Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf. 2006; 16(4):393-401. DOI: 10.1002/pds.1335. View

Gaist D, Wallander M, Gonzalez-Perez A, Garcia-Rodriguez L . Incidence of hemorrhagic stroke in the general population: validation of data from The Health Improvement Network. Pharmacoepidemiol Drug Saf. 2012; 22(2):176-82. DOI: 10.1002/pds.3391. View

HERMANS P, Diaz-Buxo J, Stobo J . Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med. 1976; 61(2):221-37. DOI: 10.1016/0002-9343(76)90173-x. View

10.

Gulmez S, Holm A, Frederiksen H, Jensen T, Pedersen C, Hallas J . Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch Intern Med. 2007; 167(9):950-5. DOI: 10.1001/archinte.167.9.950. View

11.

Sarkar M, Hennessy S, Yang Y . Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med. 2008; 149(6):391-8. DOI: 10.7326/0003-4819-149-6-200809160-00005. View

12.

Kirchheiner J, Glatt S, Fuhr U, Klotz U, Meineke I, Seufferlein T . Relative potency of proton-pump inhibitors-comparison of effects on intragastric pH. Eur J Clin Pharmacol. 2008; 65(1):19-31. DOI: 10.1007/s00228-008-0576-5. View

13.

Myles P, Hubbard R, McKeever T, Pogson Z, Smith C, Gibson J . Risk of community-acquired pneumonia and the use of statins, ace inhibitors and gastric acid suppressants: a population-based case-control study. Pharmacoepidemiol Drug Saf. 2009; 18(4):269-75. DOI: 10.1002/pds.1715. View

14.

Rodriguez L, Ruigomez A, Wallander M, Johansson S . Acid-suppressive drugs and community-acquired pneumonia. Epidemiology. 2009; 20(6):800-6. DOI: 10.1097/EDE.0b013e3181b5f27d. View

15.

Eurich D, Sadowski C, Simpson S, Marrie T, Majumdar S . Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. Am J Med. 2010; 123(1):47-53. DOI: 10.1016/j.amjmed.2009.05.032. View

16.

Johnstone J, Nerenberg K, Loeb M . Meta-analysis: proton pump inhibitor use and the risk of community-acquired pneumonia. Aliment Pharmacol Ther. 2010; 31(11):1165-77. DOI: 10.1111/j.1365-2036.2010.04284.x. View

17.

Dublin S, Walker R, Jackson M, Nelson J, Weiss N, Jackson L . Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study. Pharmacoepidemiol Drug Saf. 2010; 19(8):792-802. PMC: 2938739. DOI: 10.1002/pds.1978. View

18.

Yang Y, Metz D . Safety of proton pump inhibitor exposure. Gastroenterology. 2010; 139(4):1115-27. DOI: 10.1053/j.gastro.2010.08.023. View

19.

Seminara N, Abuabara K, Shin D, Langan S, Kimmel S, Margolis D . Validity of The Health Improvement Network (THIN) for the study of psoriasis. Br J Dermatol. 2010; 164(3):602-9. PMC: 3064479. DOI: 10.1111/j.1365-2133.2010.10134.x. View

20.

Langley T, Szatkowski L, Wythe S, Lewis S . Can primary care data be used to monitor regional smoking prevalence? An analysis of The Health Improvement Network primary care data. BMC Public Health. 2011; 11:773. PMC: 3198710. DOI: 10.1186/1471-2458-11-773. View