Risk of invasive pneumococcal disease varies by neighbourhood characteristics: implications for prevention policies.
Risk of invasive pneumococcal disease varies by neighbourhood characteristics: implications for prevention policies.
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DOI：
10.1017/s095026881200235x
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发表时间：
2013-08
影响因子：
4.2
通讯作者：
Metlay JP
中科院分区：
文献类型：
--
作者：
Feemster KA;Li Y;Localio AR;Shults J;Edelstein P;Lautenbach E;Smith T;Metlay JP
本研究调查了肺炎球菌菌血症发病率的邻里差异和与疾病风险邻里异质性相关的社区因素。我们分析了2005-2008年费城大都市以人群为基础的医院监测网络中收集的1416例成人和儿童肺炎球菌菌血症病例的数据。使用居住地址对病例进行地理编码，以按社区衡量疾病发病率，并确定潜在的社区风险因素。肺炎球菌菌血症的总体发病率为36.8例/10万人口，在281个社区中差异显著（0- 67.8例/10万人口）。疾病发病率的增加与较高的人口密度[发病率比（IRR）1·10/10 000人/英里2，95%置信区间（CI）1·0-1·19]，较高的黑人人口百分比（每增加10%）（IRR 1.07，95% CI 1.04 - 1.09）、年龄≤5岁人群（IRR 3.49，CI 1.8 - 5.18）和年龄≥65岁人群（IRR 1.19，CI 1.00 - 1.38）。在调整这些特征后，邻里疾病率没有显著差异。这项研究表明，肺炎球菌菌血症的风险，似乎是由社区的社会人口特征解释的实质性小区域的变化。查明疾病风险增加的社区可提供宝贵的信息，以优化预防战略的实施。
This study investigates neighbourhood variation in rates of pneumococcal bacteraemia and community-level factors associated with neighbourhood heterogeneity in disease risk. We analysed data from 1416 adult and paediatric cases of pneumococcal bacteraemia collected during 2005–2008 from a population-based hospital surveillance network in metropolitan Philadelphia. Cases were geocoded using residential address to measure disease incidence by neighbourhood and identify potential neighbourhood-level risk factors. Overall incidence of pneumococcal bacteraemia was 36·8 cases/100 000 population and varied significantly (0–67·8 cases/100 000 population) in 281 neighbourhoods. Increased disease incidence was associated with higher population density [incidence rate ratio (IRR) 1·10/10 000 people per mile2, 95% confidence interval (CI) 1·0–1·19], higher percent black population (per 10% increase) (IRR 1·07, 95% CI 1·04–1·09), population aged ≤5 years (IRR 3·49, CI 1·8–5·18) and population aged ≥65 years (IRR 1·19, CI 1·00–1·38). After adjusting for these characteristics, there was no significant difference in neighbourhood disease rates. This study demonstrates substantial small-area variation in pneumococcal bacteraemia risk that appears to be explained by neighbourhood sociodemographic characteristics. Identifying neighbourhoods with increased disease risk may provide valuable information to optimize implementation of prevention strategies.