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  • Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain

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Epidemiology/Health Services Research
Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain
  1. Ana Lopez-de-Andres1,
  2. Romana Albaladejo-Vicente2,
  3. Javier de Miguel-Diez3,
  4. Valentin Hernandez-Barrera1,
  5. Zichen Ji3,
  6. Jose J Zamorano-Leon4,
  7. Marta Lopez-Herranz4,
  8. Rodrigo Jimenez-Garcia1
  1. 1 Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
  2. 2 Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
  3. 3 Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
  4. 4 Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
  1. Correspondence to Professor Romana Albaladejo-Vicente; ralbadal.ucm{at}gmail.com

Abstract

Introduction To describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching.

Research design and methods This was a retrospective observational epidemiological study using the 2016–2017 Spanish Hospital Discharge Records.

Results Of 245 221 admissions, CAP was identified in 227 524 (27.67% with T2DM), VAP was identified in 2752 (18.31% with T2DM) and NV-HAP was identified in 14 945 (25.75% with T2DM). The incidence of pneumonia was higher among patients with T2DM (CAP: incidence rate ratio (IRR) 1.44, 95% CI 1.42 to 1.45; VAP: IRR 1.24, 95% CI 1.12 to 1.37 and NV-HAP: IRR 1.38, 95% CI 1.33 to 1.44). In-hospital mortality (IHM) for CAP was 12.74% in patients with T2DM and 14.16% in matched controls (p<0.001); in patients with VAP and NV-HAP, IHM was not significantly different between those with and without T2DM (43.65% vs 41.87%, p=0.567, and 29.02% vs 29.75%, p=0.484, respectively). Among patients with T2DM, older age and dialysis were factors associated with IHM for all types of pneumonia. In patients with VAP, the risk of IHM was higher in females (OR 1.95, 95% CI 1.28 to 2.96).

Conclusion The incidence rates of all types of pneumonia were higher in patients with T2DM. Higher mortality rates in patients with T2DM with any type of pneumonia were associated with older age, comorbidities and dialysis.

  • diabetes mellitus, type 2
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001447

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    Footnotes

    • Contributors AL-d-A and RJ-G were responsible for the study concept and design, participated in the interpretation of the data and drafted the manuscript. RA-V, JdM-D, ZJ, JJZ-L and ML-H searched the literature, interpreted the results and revised the manuscript. VH-B designed the analyses and performed the bulk of the data analysis. All authors critically revised the manuscript and approved the final version to be published.

    • Funding Fondo de Investigaciones Sanitarias (FIS)—Health Research Fund, Instituto de Salud Carlos III) cofinanced by the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”) of the European Union (grant no: PI16/00564).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. The data underlying the results presented in the study are available from the Spanish Ministry of Health (https://www.mscbs.gob.es/estadEstudios/estadisticas/estadisticas/estMinisterio/SolicitudCMBDdocs/Formulario_Peticion_Datos_CMBD.pdf). The data are owned by the Ministry of Health and authors do not have permission to share the data.

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