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.