Secondhand Smoke Exposure and Illness Severity among Children Hospitalized with Pneumonia

Abstract

Objective: To assess the relationship between secondhand smoke (SHS) exposure and disease severity among children hospitalized with community-acquired pneumonia (CAP).

Study design: Children hospitalized with clinical and radiographic CAP were enrolled between January 1, 2010, and June 30, 2012 at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community study. Household SHS exposure was defined based on the number of smokers in the child's home. Outcomes included hospital length of stay, intensive care unit admission, and mechanical ventilation. Proportional hazards and logistic regression models were used to assess associations between SHS exposure and outcomes. All models were adjusted for age, sex, race/ethnicity, household education level, government insurance, comorbidities, enrollment site, year, and season.

Results: Of the 2219 children included in the study, SHS exposure was reported in 785 (35.4%), including 325 (14.8%) with ≥2 smokers in the home. Compared with nonexposed children, the children exposed to ≥2 smokers had longer length of stay (median, 70.4 hours vs 64.4 hours; adjusted hazard ratio, 0.85; 95% CI, 0.75-0.97) and were more likely to receive intensive care (25.2% vs 20.9%; aOR, 1.44; 95% CI, 1.05-1.96), but not mechanical ventilation. Outcomes in children exposed to only 1 household smoker were similar to those in nonexposed children.

Conclusion: Children hospitalized with CAP from households with ≥2 smokers had a longer length of stay and were more likely to require intensive care compared with children from households with no smokers, suggesting that they experienced greater pneumonia severity.

Figure 1. Study Population

Abbreviations: CAP, community-acquired pneumonia; ¹restricted to children >9 years of age and includes 4 self-reported current smokers and 103 children with missing data

Figure 2. Length of stay for Children Hospitalized with Community-Acquired Pneumonia, According to Reported SHS Exposure

Abbreviations: aHR, adjusted hazards ratio; CI, confidence interval;; proportional hazards regression was used to model the association between home smoke exposure and hospital length of stay; model was adjusted for the following potential confounding factors selected a priori: age, sex, race/ethnicity, household education level, government insurance, individual high-risk comorbidities (persistent asthma, prematurity, neurologic disorder, cardiopulmonary disorder, and other), enrollment site, year, and season.