ABSTRACT

Background

We examined the association between intellectual disabilities (ID) and pneumonia severity at admission.

Methods

We extracted patients admitted to hospital for pneumonia from July 2010 to March 2018 using the Diagnosis Procedure Combination database. We measured pneumonia severity using the A-DROP system. After 1:4 cohort matching between patients with and without ID, we conducted conditional logistic regression and mediation analyses.

Results

Of 1,141,158 patients, 531 had ID, and they had more severe pneumonia at admission (24.5% vs. 9.5%; P < 0.001). ID was significantly associated with severe pneumonia at admission (OR = 3.50; 95% CI: 2.68–4.58) and activities of daily living (ADL) mediated 73.8% (95% CI: 50.9%–105.0%) of the total association.

Conclusions

Social barriers caused by reduced ADL may prevent patients with ID from accessing health care before their pneumonia becomes severe. Removing these barriers may decrease mortality from pneumonia among patients with ID by improving health care access.

中文翻译：

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有和无智力障碍的肺炎住院患者疾病严重程度和住院死亡率的差异：一项使用全国住院患者数据库的配对回顾性队列研究

摘要

背景

我们检查了入院时智力障碍 (ID) 与肺炎严重程度之间的关联。

方法

我们使用诊断程序组合数据库提取了 2010 年 7 月至 2018 年 3 月因肺炎住院的患者。我们使用 A-DROP 系统测量了肺炎的严重程度。在有和没有 ID 的患者之间进行 1:4 的队列匹配后，我们进行了条件逻辑回归和中介分析。

结果

在 1,141,158 名患者中，531 名患有 ID，并且他们在入院时患有更严重的肺炎（24.5% 对 9.5%；P  < 0.001）。ID 与入院时的重症肺炎显着相关（OR = 3.50；95% CI：2.68-4.58），日常生活活动（ADL）介导了总关联的 73.8%（95% CI：50.9%-105.0%）。

结论

由 ADL 减少引起的社会障碍可能会阻止 ID 患者在肺炎变得严重之前获得医疗保健。消除这些障碍可能会通过改善医疗保健的可及性来降低 ID 患者的肺炎死亡率。