OBJECTIVE -To examine whether diabetes is a risk factor for hospitalization with pneumonia and to assess the impact of A1C level on such risk. RESEARCH DESIGN AND METHODS-In this population-based, case-control study we identified patients with a first-time pneumonia-related hospitalization between 1997 and 2005, using health care databases in northern Denmark. For each case, 10 sex-and age-matched population control subjects were selected from Denmark's Civil Registration System. We used conditional logistic regression to compute relative risk (RR) for pneumonia-related hospitalization among subjects with and without diabetes, controlling for potential confounding factors.RESULTS -The study included 34,239 patients with a pneumonia-related hospitalization and 342,390 population control subjects. The adjusted RR for pneumonia-related hospitalization among subjects with diabetes was 1.26 (95% CI 1.21-1.31) compared with nondiabetic individuals. The adjusted RR was 4.43 (3.40 -5.77) for subjects with type 1 diabetes and 1.23 (1.19 -1.28) for subjects with type 2 diabetes. Diabetes duration Ն10 years increased the risk of a pneumonia-related hospitalization (1.37 [1.28 -1.47]). Compared with subjects without diabetes, the adjusted RR was 1.22 (1.14 -1.30) for diabetic subjects whose A1C level was Ͻ7% and 1.60 (1.44 -1.76) for diabetic subjects whose A1C level was Ն9%.CONCLUSIONS -Type 1 and type 2 diabetes are risk factors for a pneumonia-related hospitalization. Poor long-term glycemic control among patients with diabetes clearly increases the risk of hospitalization with pneumonia.

OBJECTIVE -We sought to examine whether type 2 diabetes increases risk of death and complications following pneumonia and to assess the prognostic value of admission hyperglycemia.RESEARCH DESIGN AND METHODS -This was a population-based cohort study of adults with a first-time hospitalization for pneumonia between 1997 and 2004 (n ϭ 29,900) in northern Denmark. Information on diabetes, comorbidity, laboratory findings, pulmonary complications, and bacteremia was obtained from medical databases. We used regression to compute adjusted relative risks of pulmonary complications, bacteremia, and mortality rate ratios (MRRs) within 90 days following hospitalization among patients with and without type 2 diabetes. The prognostic impact of admission hyperglycemia was studied in a subcohort (n ϭ 13,574).RESULTS -In total, 2,931 (9.8%) pneumonia patients had type 2 diabetes. Mortality among diabetic patients was greater than that among other patients: 19.9 vs. 15.1% after 30 days and 27.0 vs. 21.6% after 90 days, respectively, corresponding to adjusted 30-and 90-day MRRs of 1.16 (95% CI 1.07-1.27) and 1.10 (1.02-1.18). Presence of type 2 diabetes did not predict pulmonary complications or bacteremia. Adjustment for hyperglycemia attenuated the association between type 2 diabetes and mortality. High glucose level on admission was a predictor of death among patients with diabetes and more so among those without diagnosed diabetes: adjusted 30-day MRRs for glucose level Ն14 mmol/l were 1.46 (1.01-2.12) and 1.91 (1.40 -2.61), respectively. CONCLUSIONS -Type 2 diabetes and admission hyperglycemia predict increased pneumonia-related mortality. Diabetes Care 30:2251-2257, 2007M ortality among adults hospitalized with community-acquired pneumonia (CAP) ranges from 6 to 14% (1). Advanced age and comorbidity are associated with increased mortality in these patients (2-4). Given the hyperglycemia, decreased immunity, impaired lung function, and chronic complications, such as renal failure, heart disease, and pulmonary microangiopathy, associated with diabetes (5), it is plausible that diabetes may predict increased severity of pneumonia. However, results of recent observational studies and a meta-analysis of pneumonia-related mortality, based on pre-1996 research, were inconsistent (6 -10). The discrepancies could stem from the use of clinic-based cohorts, confounding, or incomplete follow-up. Better diagnostic surveillance of diabetic patients may result in lower-than-expected mortality from pneumonia. Most studies lack data on pneumonia severity at hospitalization in diabetic versus nondiabetic patients (6,8 -10), whereas claims that diabetic pneumonia patients have an increased risk of developing bacteremia (5,11) are questionable because data on availability of blood cultures are often absent. Evidence regarding pulmonary complications in diabetic patients with pneumonia is scant (5,7), as are data on the prognostic value of acute hyperglycemia for diabetic patients with pneumonia (10).As prevalences of diabetes (12) and pneumon...

Background:Data on the safety of selective serotonin-reuptake inhibitors (SSRIs) in pregnancy are inconsistent. We examined associations between SSRI use during early pregnancy and risk of congenital malformations in infants.Methods:Set in Northern Denmark, our population-based prevalence study included 216,042 women who had a live birth after the 20th week of gestation. We compared the prevalence of malformation in infants born to women who redeemed at least one SSRI prescription during early pregnancy with the prevalence in infants born to women who redeemed no SSRI prescriptions during their pregnancies. Drug use data were extracted from prescription databases, while data on congenital malformations were obtained from the National Registry of Patients.Results:The 2,062 women with SSRI prescriptions during early pregnancy gave birth to 105 (5.1%) infants with malformations, while the 213,712 women with no SSRI prescriptions gave birth to 7,449 (3.5%) infants with malformations. SSRI use was associated with an increased risk of malformations overall (odds ratio [OR] = 1.3; 95% confidence interval (CI): 1.1–1.6) and cardiac malformations (OR = 1.7; 95% CI: 1.1–2.5). For specific SSRIs, we found an increased risk for septal defects associated with sertraline.Conclusions:We found little overall association between use of SSRIs during pregnancy and congenital malformations, but our findings suggest an association between maternal SSRI use in early pregnancy and cardiac malformations which could be causal.

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BackgroundCurrent data on incidence of interstitial lung diseases (ILDs) are sparse and concerns about an increasing trend have been raised. We examined incidence rates (IRs) of ILDs and changes in IRs between 1995 and 2005.MethodsAll persons with a first-time hospital discharge or outpatient diagnosis of ILD were identified through the Danish National Registry of Patients, which covers all Danish hospitals. Crude and age-standardised IRs were computed for ILD overall, as well as stratified by ILD subcategories.ResultsA total of 21,765 patients with ILD were identified. Between 1995 and 1998 the overall standardised IR of ILD decreased from 27.14 (95% CI 25.82–28.46) per 100,000 person-years to 19.36 (95% CI 18.26–20.46) per 100,000 person-years. After 1998 the IR increased considerably, peaking at 34.34 (95% CI 32.84–35.85) per 100,000 person-years in 2002. Subsequently there was a slight decrease. The highest IR was observed in the non-specific category "Respiratory disorders in diseases classified elsewhere". By ILD subcategory, the greatest average increase during the study period was observed in "Respiratory disorders in diseases classified elsewhere".ConclusionThe incidence rate of ILD in Denmark increased during the study period, most pronounced for ILDs associated with systemic diseases.

Obesity may be associated with increased risk of pneumonia, but available data on this relationship are sparse and inconsistent.We followed a prospective cohort of 22,578 males and 25,973 females from the Danish Diet, Cancer and Health Study, aged 50-64 yrs and free from major chronic diseases at baseline (1993)(1994)(1995)(1996)(1997), for first-time hospitalisation with pneumonia (median follow-up 12 yrs).Compared with males of normal weight, adjusted hazard ratios (HRs) for pneumonia were 1.4 (95% CI 1.2-1.7) for males with moderate obesity (body mass index (BMI) 30.0-34.9 kg?m -2 ), and 2.0 (95% CI 1.4-2.8) for males with severe obesity (BMI o35.0 kg?m -2 ), controlling for lifestyle and educational variables. Among females the associations were weaker, with adjusted HRs of 0.8 (95% CI 0.6-1.0) for moderate obesity, and 1.2 (95% CI 0.8-1.6) for severe obesity. Adjustment for major chronic diseases diagnosed during follow-up eliminated the associations between obesity and pneumonia risk. Obesity is associated with higher risk of hospitalisation with pneumonia among males but not among females, which is apparently explained by occurrence of other chronic diseases.

OBJECTIVETo examine the association between diabetes, glycemic control, and risk of tuberculosis (TB).RESEARCH DESIGN AND METHODSWe conducted a population-based case-control study in Northern Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers.RESULTSWe identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ≥8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes.CONCLUSIONSIn the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.

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