Chest
Volume 116, Issue 2, August 1999, Pages 375-379
Journal home page for Chest

Clinical Investigations
Infection
Proportion of Community-Acquired Pneumonia Cases Attributable to Tobacco Smoking

https://doi.org/10.1378/chest.116.2.375Get rights and content

Study objectives

To assess the population-attributable risk (PAR) of smoking and the effect of tobacco smoking on the development of community-acquired pneumonia (CAP) in adults.

Design

A population-based case-control study. Information on history of smoking and other risk factors was obtained by a questionnaire administered by interview.

Setting

Mixed residential-industrial area having 74,610 adult inhabitants in Barcelona, Spain.

Participants

Two hundred five male and female patients (age, 15 to 74 years old) with CAP diagnosed between 1993 and 1995. They were matched to 475 control subjects randomly selected from the municipal census.

Results

Smoking any type of tobacco had an odds ratio (OR) of CAP of 2.0 for ever smokers (95% confidence interval [CI], 1.24 to 3.24); 1.88 for current smokers (95% CI, 1.11 to 3.19); and 2.14 for ex-smokers (95% CI, 1.26 to 3.65). A positive trend for increased risk of CAP was observed for an increase in the duration of the habit, the average number of cigarettes smoked daily, and cumulative cigarette consumption. Former smokers had a 50% reduction in the OR 5 years after the cessation of smoking. The risk of CAP attributable to the consumption of any type of tobacco in this population was 32.4% of cases (95% CI, 14.8 to 50.1%). In subjects without a history of COPD, the PAR of tobacco was 23.0% (95% CI, 3.3 to 42.7%).

Conclusion

This study gives better quantitative and qualitative evidence about the effects of tobacco smoking on the occurrence of pneumonia in the adult community.

Section snippets

Materials and Methods

Further details on cases and controls and methods of collecting information have been reported elsewhere.8 Briefly, the study was conducted in a mixed residential-industrial urban area having 74,610 inhabitants > 14 years of age in the Maresme county (Barcelona, Spain), which is situated on the Mediterranean coast. This area was selected because all of its physicians who are first contacted by patients having symptoms of CAP (ie, primary care and hospital emergency departments) undertook to

Results

Among the patients with CAP, 64.9% were current smokers of cigarettes (Table 1) or had smoked at some time during their life; among the control subjects, 56.2% were current smokers or had smoked at some time during their life. Of these, 15 patients and 24 control subjects had also smoked cigars, and 4 control subjects had also smoked pipes. The OR for ever smokers of any type of tobacco was 2.0 (95% CI, 1.24 to 3.24), for current smokers was 1.88 (95% CI, 1.11 to 3.19), and for ex-smokers was

Discussion

One of the major advantages of our case-control study is that it is population based, and one in which all CAP cases occurring in the entire population of a defined area within a 2-year period were included. Thus, we avoided the potential selection biases that affect studies restricted to hospitalized patients or selected groups of patients with pneumonia. The geographic area is relatively small, and it enabled the identification and the study of all suspected pneumonia cases registered by

Appendix

Collaborators in the study from Primary Care Centers: J. Costa, M. Tristany, E. Carrillo, M.J. Castany, C. Costa, J. Grau, G. Lozano, of Arenys; P. Subias, B. Jimeno, V. Marina, M. Casanovas, A. Gardella, M.C. Ginés, A. Bragnovich, M. Fradera, of Canet and Sant Pol de Mar; P. Flores, P. Serra, E. Torrellas, J.L. Fernandez, J. Mussoll, of Cirera Molins; A. Armada, X. Mestres, Y. Ortega, M. Roger, C. Guardiola, M.T. Gros, N. Les, of Ronda Cerdanya; M. Aizpurua, J. Domenech, J. Massons, M. Bundó,

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    Supported by the Health Research Fund of the Spanish Ministry of Health(expedient 94/0834).

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