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Does seafarers' limited access to health care increase risk for community-acquired pneumonia requiring hospital care? A longitudinal register-based analysis.

BACKGROUND
Limited access to medical care can be considered as an occupational risk of seafaring and it may predispose to developing community-acquired pneumonia (CAP) requiring hospital care. We sought to investigate the risk for CAP and other lower respiratory tract infections (LRTI) requiring hospital care among seafarers. We examined the length of hospital stay (LOS) as a proxy for severity of illness.


METHODS
The study population in this panel data analysis were all seafarers and a 20% random sample of economically active individuals aged 18-65 years who were residing in Denmark in 1997-2016, constituting more than 11 million person-years of follow-up. Annually-registered socio-demographic and work characteristics were linked to data on cause of hospital admissions. We used fixed-effects and zero-truncated Poisson regression to estimate the rate ratios of hospitalization for CAP and other LRTI, and compared LOS across the two populations.


RESULTS
The adjusted incident rate ratio (IRR) for CAP in seafarers compared to the economically active population was 1.42 (95% confidence interval [CI]: 1.15-1.77), whereas the IRR was 0.73 (95% CI: 0.38-1.42) for other LRTI. For LOS, the IRRs for CAP and other LRTI in seafarers were 1.08 (95% CI: 1.04-1.12) and 0.92 (95% CI: 0.83-1.01), respectively.


CONCLUSIONS
Our findings indicate that seafaring was associated with an increased risk for CAP requiring hospital care. Limited access to health care may be an important contributing factor.