RT Journal Article SR Electronic T1 Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses JF Journal of Epidemiology and Community Health JO J Epidemiol Community Health FD BMJ Publishing Group Ltd SP 1177 OP 1181 DO 10.1136/jech-2011-200168 VO 66 IS 12 A1 Clare J Wotton A1 Michael J Goldacre YR 2012 UL http://jech.bmj.com/content/66/12/1177.abstract AB Background Invasive pneumococcal disease is a serious infection, and it is an important cause of morbidity and mortality in certain groups of ‘at-risk’ people. Those considered ‘at-risk’ in the UK include very young children, people aged 65 years and older and people with certain serious chronic diseases, asplenia or immunosuppression. There is little evidence about whether people with immune-mediated diseases are at increased risk of pneumococcal disease and therefore may benefit from pneumococcal vaccination. Methods Retrospective cohort studies, using linked hospital data, from the longstanding Oxford Record Linkage Study (1963–2008) and from recent English national linked Hospital Episode Statistics (1999–2008); analysis of whether people with immune-mediated diseases are more likely than others to be admitted to hospital for pneumococcal disease; calculation of rate ratio for pneumococcal disease in cohorts with immune-mediated disease compared with control cohorts. Results There were elevated rate ratios for many of the immune-mediated diseases, for example, Addison's disease in England 3.8 (95% CI 3.4 to 4.2), autoimmune haemolytic anaemia 4.9 (4.4 to 5.3), Crohn's disease 2.2 (2.1 to 2.3), diabetes mellitus 3.7 (3.4 to 4.1), multiple sclerosis 3.7 (3.5 to 3.8), myxoedema 1.60 (1.58 to 1.63), pernicious anaemia 1.74 (1.66 to 1.83), primary biliary cirrhosis 3.3 (2.9 to 3.7), polyarteritis nodosa 5.0 (4.0 to 6.0), rheumatoid arthritis 2.47 (2.41 to 2.52), scleroderma 4.2 (3.8 to 4.7), Sjogren's syndrome 3.2 (2.9 to 3.5) and systemic lupus erythematosus 5.0 (4.6 to 5.4). Findings in the Oxford and all England data sets were similar. Conclusions People admitted to hospital with immune-mediated diseases are at higher risk than those with invasive pneumococcal disease. Vaccination should be considered in this group of patients.