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Invasive Pneumococcal Disease and Long-Term Outcomes in Adults and Children in Alberta
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- Author / Creator
- Versluys, Kristen
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Despite the introduction of vaccination and surveillance efforts, invasive pneumococcal disease (IPD) remains a disease of great public health concern, in terms of morbidity, mortality, and healthcare burden. The association between increased short-term (30-day) mortality following IPD has been frequently studied, however the relationship between IPD and long-term mortality is largely unknown in both adults and children.
All IPD patients in Alberta, Canada, between 1999-2019 had clinical data collected through chart reviews and were linked to provincial administrative health and vital statistic databases. Cases were age and sex matched to non-IPD general population controls. Using Cox Proportional Hazards modeling, the primary outcome was overall time to all-cause mortality. Additional outcomes were 90-day mortality compared to matched controls from the general population. In children we also assessed time to all-cause hospitalization as a surrogate marker for overall poor outcomes, and differences in severity of disease based on hospitalization status at IPD diagnosis.
Our first objective was to assess mortality in adults. Incident IPD events were identified in 4,522 patients, with an average follow-up time of 6·0 years (SD 0.05), ranging 1 day to 19 years. The mean age was 55·8 years, with 56·7% being males. There were 1937 deaths in cases compared to 2654 deaths in controls (81 deaths 1000/PY’s vs 47 deaths 1000/PY’s respectively). Overall all-cause mortality was consistently higher among cases compared to controls, adjusted hazard ratio (aHR) 1.77 (95% CI 1.67 - 1.88), but also higher within 30-day (aHR 3.75 [95% CI 3.29 - 4.28]), 30–90-day (aHR 1.56 [95% CI 1.27 - 1.93]) and greater than 90-day (aHR 1.44 [95%CI 1.34-1.55]) time intervals independently.
Our second objective was to assess mortality and hospitalizations in children. Incident IPD cases were found in 888 children, with a mean age of 3.8 years (SD 4.1) and 56.6% males. There were 49 total deaths in cases and 55 deaths in controls (4.8 deaths/1000 PY’s vs 2.7 deaths/1000 PY’s respectively). Risk of mortality was higher only in the short-term interval (aHR 8.78 [95% CI 3.33-23.18]) which ultimately influenced overall mortality to be higher (aHR 1.80 [1.22-2.64]) during the entire follow-up.
An IPD event increases risk of short, intermediate, and long-term mortality regardless of age, sex or comorbidity in adults, while it only primarily increases the risk of short-term mortality in children. Importantly, these studies help recognize the high risk IPD has on mortality, regardless of age. These findings can help clinicians focus efforts on specialized patient plans, to limit short and long-term downstream effects following acute infection.
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- Subjects / Keywords
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- Graduation date
- Fall 2021
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.