Influència dels hàbits tòxics, estils de vida, condicions ambientals i la vacuna antipneumocòccica en l'aparició de pneumònia adquirida a la comunitat en adults

Consultable des del TDXTítol obtingut de la portada digitalitzadaJustificació: encara que la pneumònia adquirida a la comunitat (PAC) és una malaltia clàssica i àmpliament estudiada, avui dia continua essent una important causa de morbimortalitat i es continua tenint un coneixement limitat dels factors que l'afavoreixen. La PAC es pot considerar una malaltia d'alta incidència, té un maneig clínic controvertit, una mortalitat important (especialment en els vells) i un cost elevat. Si a això s'hi afegeix l'aparició de resistències bacterianes als antibiòtics sembla lògic que en l'abordatge d'aquesta malaltia cada cop prengui més força la perspectiva de la prevenció. Objectius: conèixer els factors de risc d'adquirir una PAC, a la població major de 14 anys, relacionats amb els hàbits tòxics o estils de vida modificables, les condicions ambientals, laborals i de l'ahitatge, així com conèixer l'efecte de la vacuna antipneumocòccica en la prevenció de la PAC en la població major de 14 anys. Metodologia: per donar resposta a aquests objectius es va dissenyar un estudi observacional de tipus cas-control, de base poblacional, multicèntric i coordinat amb una base poblacional de 860.000 persones majors de 14 anys. Aquesta era la població necessària per, en un any, detectar 1.500 casos de PAC. Van participar 64 centres d'atenció primària de Catalunya, Andorra, València i les Illes Balears. Tots els casos de PAC diagnosticats a la població d'estudi durant el període novembre 1999 - novembre 2000 segons uns estrictes criteris clínics, radiològics i evolutius van ser inclosos. Per cada cas es va seleccionar un control aparellat per edat, sexe i centre d'atenció primària segons un procés de mostreig aleatori a partir del padró municipal. A tots ells, se'ls va administrar un extens qüestionari de factors de risc de PAC que feia referència al consum de tabac, alcohol, exposicions laborals, condicions de vida i de l'habitatge, vacunes, així com antecedents mèdics i comorbiditats. Resultats: Durant el període d'estudi es van identificar i reclutar 1.336 casos de PAC (participació 97 %) i 1.326 controls (participació 63 %), amb una edat mitjana de 57 anys i un lleuger predomini del sexe masculí (53 %). La incidència acumulada observada va ser de 1,6 casos/1.000 habitants any amb una clara relació estacional, de manera que la incidència el mes de gener era casi sis vegades superior a la dels mesos de juliol i agost. Pel que fa a la comorbiditat es va observar una associació estadísticament significativa entre la PAC i la infecció respiratòria de vies altes durant l'últim mes, la insuficiència cardíaca, la bronquitis crònica i el càncer, però no amb la diabetis, l'accident vascular cerebral ni la insuficiència renal crònica. Es va observar una associació estadísticament significativa entre el consum de tabac i la PAC independent de les esmentades comorbiditats, així com una relació dosi resposta entre la PAC i la intensitat de l'hàbit, la seva durada i la quantitat total de paquets fumats. Pel que fa al consum passiu de tabac es va observar una important interacció entre aquesta exposició i l'edat, de manera que en les persones de menys de 60 anys el consum passiu de tabac no tenia cap efecte (OR=1,0), mentre que en les de 60 anys o més s'observa un efecte significatiu (OR=1,52) amb una fracció atribuïble poblacional del 10%. En relació al consum d'alcohol es va observar un efecte significatiu només en els homes i quan el consum era superior als 80 g/dia (OR=2,34) sense que s'observi un increment del risc en consums inferiors encara que es facin diàriament. Altres variables associades a la PAC van ser l'exposició laboral a pols (OR=1,65), animals, vísceres o excrements (OR=1,78) i canvis sobtats de temperatura (OR=3,27), conviure més de 10 persones a la llar (OR=2,20), conviure o treballar amb nens de menys de 15 anys (OR=1,48) o tenir animals domèstics (OR=1,37). Les anàlisis multivariades en les que s'ajusta l'efecte de les vacunes per la comorbiditat mostren un efecte protector i estadísticament significatiu tant de la vacuna de la grip (OR=0,76) com de la vacuna antipneumocòccica (OR=0,55). Conclusions: Aquest estudi identifica diversos factors de risc modificables de PAC, el que ha de permetre dissenyar mesures preventives encaminades a disminuir la seva incidència. A més, aporta nova evidència científica sobre l'efectivitat de la vacuna de la grip i la antipneumocòccica en la prevenció de la PAC.Context: Although community-acquired pneumonia (CAP) is a well-known and widely studied disease, morbimortality is high and knowledge of the factors that favor CAP limited. CAP is a disease with high incidence, cost and mortality (especially among the elderly) and disputed clinical management. If to all this one adds antibiotic-resistant bacteria it is hardly surprising that the prevention perspective of the disease is gaining importance. Objectives: to determine the risk factors of acquiring CAP that are related to toxic habits or modifiable lifestyles, environmental, working and living conditions, as well as the effect of the antipneumococcal vaccine in preventing CAP, in a population of over 14 years of age. Methods: A population-based, multicenter, coordinated, observational, case-control study was designed with a population base of 860,000 people of over 14 years of age. This was the population needed to detect 1,500 cases of CAP in one year. Sixty-four primary health care clinics in Catalonia, Andorra, Valencia and the Balearic Islands participated in the study. All cases of CAP, diagnosed according to strict clinical, radiological and evolutional criteria between November 1999 and November 2000, were included in the study. A control matched by age, sex and primary health care clinic was selected for each case, following a random sampling process from the town census. All participants were given a detailed questionnaire on the risk factors of CAP which covered tobacco and alcohol use, occupational exposures, living and housing conditions, vaccines, and medical history and comorbidities. Results: During the study period, 1,336 cases of CAP were identified and enrolled (97% participation) and 1,326 controls were selected (63% participation) with an average age of 57 years and a slight predominance of men (53%). The accumulated incidence observed was of 1.6 cases/1,000 inhabitants/year with a marked seasonal relation reflected by the incidence in January being nearly 6 times greater than the incidence in July or August. With regard to comorbidity, a significant association was found between CAP and upper respiratory infections within the previous month, cardiac insufficiency, chronic bronchitis, and cancer, but not with diabetes, stroke, or chronic renal insufficiency. A significant association was found between smoking and CAP, independent of the above-mentioned comorbidities, and a dose-response relation between CAP and the intensity and duration of the smoking habit and the total number of packets smoked. With regard to passive smoking, a clear interaction between exposure and age was observed, there being no effect on people under 60 years of age (OR=1.0) but a significant effect was observed in people over 60 years (OR=1.52) with a population attributable fraction of 10%. Regarding alcohol consumption, a significant effect was observed for men only and when consumption was greater than 80 g/day (OR=2.34), no increased risk being observed for lower consumption even when daily. Other variables associated with CAP were occupational exposure to dust (OR=1.65), animals, offal, or excrements (OR=3.27) and sharp changes in temperature (OR=3.27), living with more than 10 people in the home (OR=2.20), living or working with children under 15 years of age (OR=1.48), or having pets (OR=1.37). Multivariate analysis where the effect of vaccines was adjusted for comorbidities showed a significant protector effect for both the influenza vaccine (OR=.76) and the antipneumococcal vaccine (OR=.55). Conclusions: This study identified several modifiable risk factors of CAP which should allow preventative measures to be designed to reduce incidence. New scientific evidence on the effectiveness of the influenza and antipneumococcal vaccines in the prevention of CAP has also been presented

Efecto de la fragilidad en el consumo de recursos sanitarios en ancianos con cáncer

Objective: To evaluate the effect of frailty on health resource use in aged population with cancer. Method: Population -based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people >= 65 years with cancer. Results: Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p = 0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). Conclusions: Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer. (c) 2024 SESPAS. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Healthcare-related cost of oropharyngeal dysphagia and its complications pneumonia and malnutrition after stroke : a systematic review

Objectives: To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death). Design: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Data sources: MEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019. Participants: Patients with poststroke. Primary outcome measures: The costs associated to poststroke OD and its complications. Data analysis: Data were synthetised narratively, quality evaluation was done using an adaptation of Drummond's checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence. Results: A total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition. Conclusions: This systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heteogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD

Eficacia de un sistema personalizado de dosificación (SPD) en la mejoría del cumplimiento terapéutico en ancianos polimedicados

ObjetivoEl objetivo de este estudio es evaluar la eficacia del sistema personalizado de dosificación (SPD) en la mejora del cumplimiento terapéutico y el control de las enfermedades de base en pacientes mayores diabéticos e hipertensos.DiseñoEnsayo clínico controlado y aleatorizado. El protocolo de estudio obtuvo la aprobación del Comité Ético de Ensayos Clínicos del centro.EmplazamientoPoblación adscrita en 2 centros de atención primaria de la ciudad de Mataró (Barcelona).ParticipantesSe incluyó a individuos mayores de 64 años, residentes en la comunidad, diagnosticados de diabetes mellitus (según criterios OMS-1998) e hipertensión arterial (presión arterial sistólica>140 mmHg y/o diastólica>90 mmHg) que tomaban 3 o más fármacos (en forma oral sólida) al día. Se excluyó a los pacientes diagnosticados de demencia o enfermedad mental grave y los que no dieron su consentimiento para participar en el estudio. Entre octubre de 2002 y enero de 2003 se procedió a la selección de los pacientes. Después de firmar la hoja de consentimiento informado, fueron asignados aleatoriamente a uno de los siguientes grupos de intervención: a) grupo de intervención (SPD), o b) grupo control (procedimiento habitual). La aleatorización se realizó a través de unos sobres opacos, cerrados y numerados.Intervenciones del estudioLos pacientes asignados al grupo SPD fueron derivados con el tratamiento habitual a unas determinadas oficinas de farmacia donde se les suministraba toda la medicación semanal en un contenedor SPD (Venalink®) y se les recogía el de la semana anterior con los comprimidos que no se hubiesen ingerido1. El SPD es un dispositivo desechable especialmente diseñado para facilitar la toma correcta de los medicamentos en el que el farmacéutico pone toda la medicación sólida que toma el paciente, en el orden posológico prescrito, en un contenedor que identifica mediante colores y pictogramas el día y la toma, así como algunas indicaciones especiales (ayunas, líquidos abundantes, etc.). Los participantes del grupo control eran libres de acudir a la oficina de farmacia que quisieran y seguían el sistema habitual de dispensación de fármacos.Principales medidas del resultadoMedidas del cumplimiento del tratamiento: a) recuento de comprimidos al final del primer mes (en el grupo SPD lo realizó el farmacéutico a partir de los dispositivos devueltos y en el grupo control, la enfermera del centro de atención primaria), y b) cuestionarios de Haynes-Sackett y de Morisky-Green2 que se administraron al inicio y alos 6 meses de seguimiento. Medidas de control de la enfermedad de base: HbA1c, glucemia en ayunas y presión arterial al inicio y en el control de los 6 meses de seguimiento.ResultadosSe seleccionó a 47 individuos (24 en el grupo SPD y 23 controles). No se encontraron diferencias significativas, entre los dos grupos de estudio, en las características sociodemográficas ni en la prevalencia de distintas comorbilidades (tabla 1) y el número de dosis diarias (7,9 dosis/día en el grupo SPD frente a 7,1 en el grupo control). Según el recuento de comprimidos realizado al final del primer mes, en el grupo control (n=21) se observó un cumplimiento del 73,5%, mientras que en el grupo SPD (n=20) éste fue del 98,9% (p=0,001). En la tabla 1 se compara el porcentaje de mal cumplidores entre los 2 grupos de estudio según recuento de comprimidos al mes de seguimiento y según cuestionarios de Morisky-Green y Haynes- Sackett a los 6 meses de seguimiento, y también se muestran los resultados referentes al control de la diabetes y la presión arterial.Discusión y conclusionesSegún el recuento de comprimidos, en las personas mayores polimedicadas el dispositivo SPD podría incrementar el cumplimiento terapéutico, alcanzando unos valores de cumplimiento óptimos al primer mes de seguimiento. Otros autores han obtenido resultados positivos al estudiar el efecto del SPD3, aunque sorprende el alto cumplimiento (cercano al 100%) observado en el grupo de estudio, muy superior al descrito en otros estudios4. Además, no se ha observado ningún efecto del SPD cuando se consideran los cuestionarios de cumplimiento terapéutico de Morisky-Green o de Haynes-Sackett. Por otro lado, como se ha descrito en la bibliografía5, en el presente trabajo la mejoría en el cumplimiento terapéutico tampoco se traduce en una mejoría significativa en el control de las enfermedades de base, lo que podría explicarse por la limitada muestra del estudio, el limitado período de seguimiento o el hecho de que hay otros factores no farmacológicos, como el ejercicio o la dieta, que pueden condicionar el correcto control de la diabetes y la hipertensión. Las principales limitaciones del presente trabajo son: a) el recuento de comprimidos tras la devolución del blister SPD no fue previamente validado ni confrontado con el recuento de comprimidos realizado en condiciones estándares (por sorpresa al domicilio del paciente para que éste no pueda realizar engaño intencionado)6, y b) las pérdidas de seguimiento a lo largo del período de estudio (25% en el grupo SPD y 26% en el grupo control a los 6 meses). Hacen falta más estudios, a más largo plazo y con una muestra mayor de individuos que aporten más evidencias sobre el efecto de este sistema de dispensación de la medicación, especialmente en términos de mejora del control de las enfermedades de base. Aunque la evidencia científica sobre la eficacia del SPD no es concluyente, este estudio aporta algunos datos que indican que este dispositivo podría ser útil para mejorar el cumplimiento con el tratamiento en ancianos con alto riesgo de ser mal cumplidores

Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke : protocol for a systematic review

Oropharyngeal dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. PROSPER

Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia

To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). (...

Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke : A Systematic Review

Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost-utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed

Microbiological study of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and the usefulness of analytical and clinical parameters in its identification (VIRAE study)

Ramon Boixeda,1,5 Nuria Rabella,2 Goretti Sauca,3 Maria Delgado,1 Xavier Martinez-Costa1, Montserrat Mauri,1 Vanessa Vicente,1 Elisabet Palomera,4 Mateu Serra-Prat,4 Josep Antón Capdevila11Department of Internal Medicine, Hospital of Mataró, Barcelona, Spain; 2Department of Microbiology, Hospital of Santa Creu and Sant Pau, Barcelona, Spain; 3Department of Microbiology, Hospital of Mataró, Barcelona, Spain; 4Department of Research, Hospital of Mataró, Barcelona, Spain; 5Department of Medicine, Autonomous University of Barcelona, Barcelona, SpainPurpose: Respiratory infection is the most common cause for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). The aim of this work was to study the etiology of the respiratory infection in order to assess the usefulness of the clinical and analytical parameters used for COPD identification.Patients and methods: We included 132 patients over a period of 2 years. The etiology of the respiratory infection was studied by conventional sputum, paired serology tests for atypical bacteria, and viral diagnostic techniques (immunochromatography, immunofluorescence, cell culture, and molecular biology techniques). We grouped the patients into four groups based on the pathogens isolated (bacterial versus. viral, known etiology versus unknown etiology) and compared the groups.Results: A pathogen was identified in 48 patients. The pathogen was identified through sputum culture in 34 patients, seroconversion in three patients, and a positive result from viral techniques in 14 patients. No significant differences in identifying etiology were observed in the clinical and analytical parameters within the different groups. The most cost-effective tests were the sputum test and the polymerase chain reaction.Conclusion: Based on our experience, clinical and analytical parameters are not useful for the etiological identification of COPD exacerbations. Diagnosing COPD exacerbation is difficult, with the conventional sputum test for bacterial etiology and molecular biology techniques for viral etiology providing the most profitability. Further studies are necessary to identify respiratory syndromes or analytical parameters that can be used to identify the etiology of new AE-COPD cases without the laborious diagnostic techniques.Keywords: respiratory viruses, chronic obstructive pulmonary disease, exacerbation, diagnostic tests, hospitalizatio

Healthcare costs of post-stroke oropharyngeal dysphagia and its complications : malnutrition and respiratory infections

Altres ajuts: Acord transformatiu CRUE-CSICFinancial support received from research grants from Nutricia Danone Advanced Medical Nutrition (HESDY Grant); Fundació Salut del CSdM, Strategic Action Grant in Oropharyngeal Dysphagia provided by the Centro de Investigación Biomédica en Red en el Área de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, DJO Global, and la Fundació la Marató de TV3 (11/2310).Background and purpose: The healthcare economic costs of post-stroke oropharyngeal dysphagia (OD) are not fully understood. The purpose of this study was to assess the acute, subacute and long-term costs related to post-stroke OD and its main complications (malnutrition and respiratory infections). Methods: A cost of illness study of patients admitted to Mataró Hospital (Catalonia, Spain) from May 2010 to September 2014 with a stroke diagnosis was performed. OD, malnutrition and respiratory infections were assessed during hospitalization and follow-up (3 and 12 months). Hospitalization and long-term costs were measured from hospital and healthcare system perspectives. Multivariate linear regression analysis was performed to assess the independent effect of OD, malnutrition and respiratory infections on healthcare costs during hospitalization, and at 3 and 12 months' follow-up. Results: In all, 395 patients were included of whom 178 had OD at admission. Patients with OD incurred major total in-hospital costs (€5357.67 ± €3391.62 vs. €3976.30 ± €1992.58, p < 0.0001), 3-month costs (€8242.0 ± €5376.0 vs. €5320.0 ± €4053.0, p < 0.0001) and 12-month costs (€11,617.58 ± €12,033.58 vs. €7242.78 ± €7402.55, p < 0.0001). OD was independently associated with a cost increase of €789.68 (p = 0.011) during hospitalization and of €873.5 (p = 0.084) at 3 months but not at 12 months. However, patients with OD who were at risk of malnutrition or malnourished and suffered respiratory infections incurred major mean costs compared with those patients without OD (€19,817.58 ± €13,724.83 vs. €7242.8 ± €7402.6, p < 0.0004) at 12 months' follow-up. Conclusion: Oropharyngeal dysphagia causes significant high economic costs during hospitalization that strongly and significantly increase with the development of malnutrition and respiratory infections at long-term follow-up

Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case-control study

OBJECTIVE: To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults. SETTING: A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age. PARTICIPANTS: 1003 participants who had never smoked were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. METHODS: A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis. RESULTS: The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10(-3) inhabitants in passive smokers and 0.90×10(-3) in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10(-3) in passive smokers and 1.69×10(-3) in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45). CONCLUSIONS: Passive smoking at home is a risk factor for CAP in older adults (65 years or more)