Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season: pleiotropic benefits or residual confounding?
Identifieur interne : 000765 ( Main/Exploration ); précédent : 000764; suivant : 000766Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season: pleiotropic benefits or residual confounding?
Auteurs : Dean T. Eurich [Canada] ; Thomas J. Marrie ; Jennie Johnstone ; Sumit R. MajumdarSource :
- American journal of respiratory and critical care medicine [ 1535-4970 ] ; 2008.
Descripteurs français
- KwdFr :
- Alberta (épidémiologie), Analyse appariée, Analyse multivariée, Femelle, Humains, Infections communautaires (mortalité), Modificateur d'effet épidémiologique, Modèles logistiques, Mortalité hospitalière, Mâle, Pneumopathie infectieuse (), Pneumopathie infectieuse (mortalité), Saisons, Sujet âgé, Vaccination, Vaccins antigrippaux, Études cas-témoins, Études prospectives.
- MESH :
- mortalité : Infections communautaires, Pneumopathie infectieuse.
- épidémiologie : Alberta.
- Analyse appariée, Analyse multivariée, Femelle, Humains, Modificateur d'effet épidémiologique, Modèles logistiques, Mortalité hospitalière, Mâle, Pneumopathie infectieuse, Saisons, Sujet âgé, Vaccination, Vaccins antigrippaux, Études cas-témoins, Études prospectives.
English descriptors
- KwdEn :
- Aged, Alberta (epidemiology), Bias, Case-Control Studies, Community-Acquired Infections (mortality), Effect Modifier, Epidemiologic, Female, Hospital Mortality, Humans, Influenza Vaccines, Logistic Models, Male, Matched-Pair Analysis, Multivariate Analysis, Pneumonia (mortality), Pneumonia (prevention & control), Prospective Studies, Seasons, Vaccination.
- MESH :
- chemical : Influenza Vaccines.
- epidemiology : Alberta.
- mortality : Community-Acquired Infections, Pneumonia.
- prevention & control : Pneumonia.
- Aged, Bias, Case-Control Studies, Effect Modifier, Epidemiologic, Female, Hospital Mortality, Humans, Logistic Models, Male, Matched-Pair Analysis, Multivariate Analysis, Prospective Studies, Seasons, Vaccination.
Abstract
RATIONALE
Observational studies suggest a 50% mortality reduction for older patients receiving influenza vaccination; some deem this magnitude of benefit implausible and invoke confounding by the "healthy user effect" as an alternate explanation.
OBJECTIVES
To evaluate unrecognized confounding by hypothesizing the presence of a 50% mortality reduction with vaccination for patients with pneumonia outside of influenza season.
METHODS
Clinical, laboratory, and functional data were prospectively collected on 1,813 adults with community-acquired pneumonia admitted to six hospitals outside of influenza season in the Capital Health region (AB, Canada). Vaccination status was ascertained by interview and chart review. Outcome was in-hospital mortality. Influenza-vaccinated patients were matched to a nonvaccinated control using propensity scores, and then multivariable regression was used to determine the independent association between vaccination and mortality.
MEASUREMENTS AND MAIN RESULTS
The cohort consisted of 352 vaccine recipients and 352 matched control subjects. Most (85%) patients were 65 years or older, 29% had severe pneumonia, and 12% died. Influenza vaccination was associated with a 51% mortality reduction (28 of 352 [8%] died vs. 53 of 352 [15%] control subjects; unadjusted odds ratio [OR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = 0.004) outside influenza season. Adjustment for age, sex, and comorbidities did not alter these findings (adjusted OR, 0.45; 95% CI, 0.27-0.76). More complete adjustment for confounding (e.g., functional and socioeconomic status) markedly attenuated these benefits and their statistical significance (adjusted OR, 0.81; 95% CI, 0.35-1.85; P = 0.61).
CONCLUSIONS
The 51% reduction in mortality with vaccination initially observed in patients with pneumonia who did not have influenza was most likely a result of confounding. Previous observational studies may have overestimated mortality benefits of influenza vaccination.
DOI: 10.1164/rccm.200802-282OC
PubMed: 18556629
Affiliations:
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Marrie</name></author><author><name sortKey="Johnstone, Jennie" sort="Johnstone, Jennie" uniqKey="Johnstone J" first="Jennie" last="Johnstone">Jennie Johnstone</name></author><author><name sortKey="Majumdar, Sumit R" sort="Majumdar, Sumit R" uniqKey="Majumdar S" first="Sumit R" last="Majumdar">Sumit R. Majumdar</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2008">2008</date><idno type="RBID">pubmed:18556629</idno><idno type="pmid">18556629</idno><idno type="doi">10.1164/rccm.200802-282OC</idno><idno type="wicri:Area/Main/Corpus">000814</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000814</idno><idno type="wicri:Area/Main/Curation">000814</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000814</idno><idno type="wicri:Area/Main/Exploration">000814</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season: pleiotropic benefits or residual confounding?</title><author><name sortKey="Eurich, Dean T" sort="Eurich, Dean T" uniqKey="Eurich D" first="Dean T" last="Eurich">Dean T. Eurich</name><affiliation wicri:level="1"><nlm:affiliation>Department of Public Health Sciences, School of Public Health, University of Alberta, 13-103 Clinical Sciences Bldg., Edmonton, AB, T6G 2G3 Canada. deurich@ualberta.ca</nlm:affiliation><country wicri:rule="url">Canada</country></affiliation></author><author><name sortKey="Marrie, Thomas J" sort="Marrie, Thomas J" uniqKey="Marrie T" first="Thomas J" last="Marrie">Thomas J. Marrie</name></author><author><name sortKey="Johnstone, Jennie" sort="Johnstone, Jennie" uniqKey="Johnstone J" first="Jennie" last="Johnstone">Jennie Johnstone</name></author><author><name sortKey="Majumdar, Sumit R" sort="Majumdar, Sumit R" uniqKey="Majumdar S" first="Sumit R" last="Majumdar">Sumit R. Majumdar</name></author></analytic><series><title level="j">American journal of respiratory and critical care medicine</title><idno type="eISSN">1535-4970</idno><imprint><date when="2008" type="published">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Alberta (epidemiology)</term><term>Bias</term><term>Case-Control Studies</term><term>Community-Acquired Infections (mortality)</term><term>Effect Modifier, Epidemiologic</term><term>Female</term><term>Hospital Mortality</term><term>Humans</term><term>Influenza Vaccines</term><term>Logistic Models</term><term>Male</term><term>Matched-Pair Analysis</term><term>Multivariate Analysis</term><term>Pneumonia (mortality)</term><term>Pneumonia (prevention & control)</term><term>Prospective Studies</term><term>Seasons</term><term>Vaccination</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Alberta (épidémiologie)</term><term>Analyse appariée</term><term>Analyse multivariée</term><term>Femelle</term><term>Humains</term><term>Infections communautaires (mortalité)</term><term>Modificateur d'effet épidémiologique</term><term>Modèles logistiques</term><term>Mortalité hospitalière</term><term>Mâle</term><term>Pneumopathie infectieuse ()</term><term>Pneumopathie infectieuse (mortalité)</term><term>Saisons</term><term>Sujet âgé</term><term>Vaccination</term><term>Vaccins antigrippaux</term><term>Études cas-témoins</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Alberta</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Community-Acquired Infections</term><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Infections communautaires</term><term>Pneumopathie infectieuse</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Alberta</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Bias</term><term>Case-Control Studies</term><term>Effect Modifier, Epidemiologic</term><term>Female</term><term>Hospital Mortality</term><term>Humans</term><term>Logistic Models</term><term>Male</term><term>Matched-Pair Analysis</term><term>Multivariate Analysis</term><term>Prospective Studies</term><term>Seasons</term><term>Vaccination</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Analyse appariée</term><term>Analyse multivariée</term><term>Femelle</term><term>Humains</term><term>Modificateur d'effet épidémiologique</term><term>Modèles logistiques</term><term>Mortalité hospitalière</term><term>Mâle</term><term>Pneumopathie infectieuse</term><term>Saisons</term><term>Sujet âgé</term><term>Vaccination</term><term>Vaccins antigrippaux</term><term>Études cas-témoins</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>RATIONALE</b></p><p>Observational studies suggest a 50% mortality reduction for older patients receiving influenza vaccination; some deem this magnitude of benefit implausible and invoke confounding by the "healthy user effect" as an alternate explanation.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To evaluate unrecognized confounding by hypothesizing the presence of a 50% mortality reduction with vaccination for patients with pneumonia outside of influenza season.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Clinical, laboratory, and functional data were prospectively collected on 1,813 adults with community-acquired pneumonia admitted to six hospitals outside of influenza season in the Capital Health region (AB, Canada). Vaccination status was ascertained by interview and chart review. Outcome was in-hospital mortality. Influenza-vaccinated patients were matched to a nonvaccinated control using propensity scores, and then multivariable regression was used to determine the independent association between vaccination and mortality.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND MAIN RESULTS</b></p><p>The cohort consisted of 352 vaccine recipients and 352 matched control subjects. Most (85%) patients were 65 years or older, 29% had severe pneumonia, and 12% died. Influenza vaccination was associated with a 51% mortality reduction (28 of 352 [8%] died vs. 53 of 352 [15%] control subjects; unadjusted odds ratio [OR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = 0.004) outside influenza season. Adjustment for age, sex, and comorbidities did not alter these findings (adjusted OR, 0.45; 95% CI, 0.27-0.76). More complete adjustment for confounding (e.g., functional and socioeconomic status) markedly attenuated these benefits and their statistical significance (adjusted OR, 0.81; 95% CI, 0.35-1.85; P = 0.61).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The 51% reduction in mortality with vaccination initially observed in patients with pneumonia who did not have influenza was most likely a result of confounding. Previous observational studies may have overestimated mortality benefits of influenza vaccination.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">18556629</PMID><DateCompleted><Year>2008</Year><Month>09</Month><Day>16</Day></DateCompleted><DateRevised><Year>2017</Year><Month>11</Month><Day>16</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1535-4970</ISSN><JournalIssue CitedMedium="Internet"><Volume>178</Volume><Issue>5</Issue><PubDate><Year>2008</Year><Month>Sep</Month><Day>01</Day></PubDate></JournalIssue><Title>American journal of respiratory and critical care medicine</Title><ISOAbbreviation>Am. J. Respir. Crit. Care Med.</ISOAbbreviation></Journal><ArticleTitle>Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season: pleiotropic benefits or residual confounding?</ArticleTitle><Pagination><MedlinePgn>527-33</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1164/rccm.200802-282OC</ELocationID><Abstract><AbstractText Label="RATIONALE" NlmCategory="BACKGROUND">Observational studies suggest a 50% mortality reduction for older patients receiving influenza vaccination; some deem this magnitude of benefit implausible and invoke confounding by the "healthy user effect" as an alternate explanation.</AbstractText><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To evaluate unrecognized confounding by hypothesizing the presence of a 50% mortality reduction with vaccination for patients with pneumonia outside of influenza season.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Clinical, laboratory, and functional data were prospectively collected on 1,813 adults with community-acquired pneumonia admitted to six hospitals outside of influenza season in the Capital Health region (AB, Canada). Vaccination status was ascertained by interview and chart review. Outcome was in-hospital mortality. Influenza-vaccinated patients were matched to a nonvaccinated control using propensity scores, and then multivariable regression was used to determine the independent association between vaccination and mortality.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS" NlmCategory="RESULTS">The cohort consisted of 352 vaccine recipients and 352 matched control subjects. Most (85%) patients were 65 years or older, 29% had severe pneumonia, and 12% died. Influenza vaccination was associated with a 51% mortality reduction (28 of 352 [8%] died vs. 53 of 352 [15%] control subjects; unadjusted odds ratio [OR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = 0.004) outside influenza season. Adjustment for age, sex, and comorbidities did not alter these findings (adjusted OR, 0.45; 95% CI, 0.27-0.76). More complete adjustment for confounding (e.g., functional and socioeconomic status) markedly attenuated these benefits and their statistical significance (adjusted OR, 0.81; 95% CI, 0.35-1.85; P = 0.61).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The 51% reduction in mortality with vaccination initially observed in patients with pneumonia who did not have influenza was most likely a result of confounding. Previous observational studies may have overestimated mortality benefits of influenza vaccination.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Eurich</LastName><ForeName>Dean T</ForeName><Initials>DT</Initials><AffiliationInfo><Affiliation>Department of Public Health Sciences, School of Public Health, University of Alberta, 13-103 Clinical Sciences Bldg., Edmonton, AB, T6G 2G3 Canada. deurich@ualberta.ca</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marrie</LastName><ForeName>Thomas J</ForeName><Initials>TJ</Initials></Author><Author ValidYN="Y"><LastName>Johnstone</LastName><ForeName>Jennie</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Majumdar</LastName><ForeName>Sumit R</ForeName><Initials>SR</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter 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MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000416" MajorTopicYN="N">Alberta</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015982" MajorTopicYN="N">Bias</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016022" MajorTopicYN="N">Case-Control Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017714" MajorTopicYN="N">Community-Acquired Infections</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015987" MajorTopicYN="N">Effect Modifier, Epidemiologic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007252" MajorTopicYN="Y">Influenza Vaccines</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016015" MajorTopicYN="N">Logistic Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016555" MajorTopicYN="N">Matched-Pair Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011014" MajorTopicYN="N">Pneumonia</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012621" MajorTopicYN="Y">Seasons</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014611" MajorTopicYN="Y">Vaccination</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2008</Year><Month>6</Month><Day>17</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2008</Year><Month>9</Month><Day>17</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2008</Year><Month>6</Month><Day>17</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">18556629</ArticleId><ArticleId IdType="pii">200802-282OC</ArticleId><ArticleId IdType="doi">10.1164/rccm.200802-282OC</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li></country></list><tree><noCountry><name sortKey="Johnstone, Jennie" sort="Johnstone, Jennie" uniqKey="Johnstone J" first="Jennie" last="Johnstone">Jennie Johnstone</name><name sortKey="Majumdar, Sumit R" sort="Majumdar, Sumit R" uniqKey="Majumdar S" first="Sumit R" last="Majumdar">Sumit R. Majumdar</name><name sortKey="Marrie, Thomas J" sort="Marrie, Thomas J" uniqKey="Marrie T" first="Thomas J" last="Marrie">Thomas J. Marrie</name></noCountry><country name="Canada"><noRegion><name sortKey="Eurich, Dean T" sort="Eurich, Dean T" uniqKey="Eurich D" first="Dean T" last="Eurich">Dean T. Eurich</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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