Introduction Our aim was to quantify the risk of community-acquired infective pneumonia (CAP) among patients with coeliac disease (CD), vaccinated and unvaccinated against pneumococcus, compared to the general population.
Method We identified all subjects with diagnosed CD within the Clinical Practice Research Datalink linked with Hospital Episodes Statistics between 1stApril 1997 and 31stMarch 2011 and up to 10 controls per CD patient by frequency matching within 10-year age bands. We calculated rates per 1000 person-years of the first CAP among all patients with CD and controls, separately in those vaccinated and unvaccinated against pneumococcus, and in CD patients before and after their diagnosis. We used a Cox regression model to estimate the hazard ratio (HR) of pneumonia among CD patients compared to the controls.
Results Among 9,803 CD patients and 101,755 controls, respectively there were 179 (1.82%) and 1864 (1.83%) CAP events. The overall rate of CAP in CD was 3.42 per 1000 person-years and 3.12 per 1000 person-years in controls. We found an increased risk of pneumonia among the unvaccinated CD patients compared to unvaccinated controls (HR 1.28, 95% CI 1.02–1.60), but not in vaccinated CD patients compared to vaccinated controls (HR 0.88, 95% CI 0.70–1.10). The increased risk in unvaccinated CD subjects was limited to those younger than 65 years, was particularly increased around the time of diagnosis (HR 2.31, 95% CI 1.03–5.19 within 1 year after diagnosis) and was maintained for more than 5 years after diagnosis (Table 1).
Conclusion Unvaccinated people with CD under the age of 65 have a higher risk of CAP compared to the general population around the time of diagnosis and subsequently. Pneumococcal vaccination in people with CD following diagnosis and treatment would appear to be good medical advice.
Disclosure of interest None Declared.