Socioeconomic status and migration background as predictors of complicated lower respiratory tract infections in primary care

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BACKGROUND: Evidence on risk factors for a complicated course of lower respiratory tract infections (LRTIs) in primary care remains limited and often consensus based. While socioeconomic status (SES) and migration background have been linked to complicated LRTIs in population-based studies, their predictive value in primary care remains unclear. Consequently, these factors are not incorporated within current guidelines, which may contribute to health inequalities. Therefore, we aimed to evaluate the added value of SES and migration background as predictive factors of a complicated course of LRTIs in primary care. METHODS: Routine care data from Dutch general practices participating in the Extramural LUMC Academic Network database (Leiden-The Hague-Zoetermeer region) from 2014 to 2023, excluding COVID-19 years, was linked to sociodemographic and hospital claims data from Statistic Netherlands. Adults presenting with LRTI complaints were included (n = 145,445). Multivariable logistic regression models were constructed to predict 30-day hospitalisation or death following LRTI. Models included conventional risk factors with SES and migration background subsequently added. RESULTS: In this study we show that after adjusting for conventional clinical factors, SES is a strong predictor of a complicated course of LRTI, whereas migration background is not. Patients in the lowest SES category have an adjusted odds ratio of 1.46 (95%CI: 1.31 - 1.62) for a complicated course compared to the highest. CONCLUSIONS: SES is a strong predictor of a complicated course of LRTI in primary care, even after adjusting for conventional risk factors. The incorporation of SES into clinical decision tools and guidelines has the potential to enhance risk-stratification of patients with LRTI in daily practice of primary care, thereby supporting more equitable care.

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