Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Monica L.W. Pecha, BS¹, Cam Solomon, PhD², Kun (Sue) Gao, PhD Candidate³, and Annette L. Fitzpatrick, PhD, MA¹. (1) Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195-7236, 240.498.6040, mlwpecha@u.washington.edu, (2) Department of Biostatistics, University of Washington, Box 354922, Seattle, WA 98115, (3) Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195

OBJECTIVE: To investigate the relationship between the pneumococcal polysaccharide vaccination (PPV) status and subsequent pneumonia hospitalization. METHODS: In this study, 5888 non-institutionalized participants of the Cardiovascular Health Study were enrolled from four clinical centers in the United States. Analyses were completed on the entire cohort and excluding 1543 participants who entered the study already vaccinated. Cox proportional-hazards models were used to examine the relationship between pneumonia hospitalization and PPV, with adjustment for participant characteristics, comorbidities, and influenza vaccination at baseline. RESULTS: The mean age of the cohort was 73 years at baseline (Std. Dev. 5.6 years) and 57.6% were female. Average follow-up was 9.5 years (Std. Dev. 3.6 years). During the study period from 1989 through 2002, there were 857 first pneumonia hospitalizations (defined by ICD-9 codes 480-487.0, 38.0, 38.2, 41.0, 41.2, 320.1). Overall 26.2% participants were vaccinated prior to baseline (PPV date unknown), 32.9% during the study, and 40.9% were unvaccinated. No association was found between vaccination and subsequent pneumonia hospitalization in the entire cohort (HR: 1.01, 95% CI: 0.88 - 1.15). However, when the sample was restricted to persons newly vaccinated during follow-up, the risk of subsequent pneumonia hospitalization was reduced by about 20% (HR: 0.81, 95% CI: 0.68 - 0.97). The association remained after adjustment for other factors (HR: 0.82, 95% CI: 0.68 - 1.00). CONCLUSIONS: These findings suggest that PPV may be effective in reducing pneumonia hospitalizations in older adults. Confounding by indication may be a factor in the inconsistent findings reported in the literature on PPV.

Learning Objectives:

(
• Evaluate the risk of respiratory hospitalization in non-institutionalized older adults in relation to vaccination and comorbidity status. (
• Discuss epidemiological and biostatistical method for control of confounding by indication.

Keywords: Elderly, Immunizations

Awards: Retirement Research Foundation Masters Student Award - Recipient

Presenting author's disclosure statement:

Any relevant financial relationships? No