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Achoo, achis, ATCHIN! Vaccine you…
... Our results justify the need for preventive strategies after discharge. Immunization programs, such as pneumococcal and influenza vaccinations, and reducing environmental risk factors by supporting lifestyle modification such as regular physical activity and balanced diet may improve long-term outcomes [29]. Also, better understanding the causal association between CAP and long-term mortality is vital for improving outcomes in the older adults with CAP. ...
Introduction:
We aimed to determine the indicators for poor long-term outcome in older adults with community-acquired pneumonia (CAP).
Methodology:
Patients with CAP requiring hospitalization were included in this retrospective study. The long-term mortality was defined as all-cause 1-year mortality following hospital admission.
Results:
A total of 145 patients with CAP were recorded. The median age was 70 (18-103), of whom 94 (65%) were ≥ 65 years old and 86 (59.5%) were male. Long-term mortality rates following CAP requiring hospitalization were substantially high in both the younger (n = 16, 31.4%) and older adults (n=43, 45.7%). In univariate analysis, the Pneumonia Severity Index (PSI) (p = 0.007), mechanical ventilation (p > 0.001), mental status changes (p = 0.018) as well as the modified Charlson Comorbidity Index (p=0.001), presence of malignancy (p < 0.001) and hospital readmission (p < 0.001) were associated with long-term mortality in the older group. Our results revealed that the need for mechanical ventilation (OR = 47.61 CI = 5.38-500.0, p = 0.001) and hospital readmission (OR = 15.87 CI = 5.26-47.61, p < 0.001) were major independent predictors of 1-year mortality.
Conclusions:
Clinicians should consider the lethal possibilities of CAP even after hospital discharge. The need for mechanical ventilation and hospital readmission may predict long-term mortality. Therefore, the patients who have these predictors should be closely monitored.
... A study from Brazil about the frequency of sarcopenia in elderly patients hospitalized, reported that of the 110 patients included in the study, the frequency of sarcopenia was 22% (representing one in five elderly patients hospitalized), with 10.0% being of the severe type. The factors associated with sarcopenia were age, clinical profile in admission and smoking [39]. Improving muscle strength and physical performance may be improved with exercise interventions. ...
Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy. Streptococcus pneumoniae remains the most frequently reported pathogen in this population. However, particular attention should be paid to patients with risk factors for multidrug resistant pathogens, because a large proportion of elderly persons present multimorbidity. Vaccination is one of the most important preventive approaches for CAP in the elderly. In addition, lifestyle-tailored interventions for different modifiable risk factors will help to reduce the risk of pneumonia in elderly persons. Surveillance of etiological pathogens may improve vaccination policies in this population.
Introduction
Hospitalizations due to community-acquired pneumonia (CAP) in mainland Portugal from 2000 to 2009 accounted for 3.7% of all hospital admissions in population with 18 or more years of age. There is no direct-cost data regarding these admissions.
Methods
In this observational descriptive study all adult hospitalizations associated with CAP diagnosis were retrospectively analyzed for the period between 2000 and 2009. Patients under 18 years old, those with pneumonia as secondary diagnosis, patients with tuberculous or obstructive pneumonia, and immunocompromised patients were excluded from the study. The direct cost of hospitalization was calculated according to the diagnosis-related groups (DRG), established for the respective year of hospitalization.
Results
There were 294,026 hospital admissions with an average annual direct cost of 80 million Euros, which almost doubled between 2000 and 2009. The average direct hospitalization costs per admission, including wards and Intensive Care Units (ICU), amounted to €2,707, with an increasing trend. The average hospitalization cost was €2,515 for admissions resulting in live discharge, and €3,457 for the deceased.
Conclusion
The average direct cost of adult hospitalizations associated with CAP amounted to €2,707 in mainland Portugal from 2000 to 2009, showing an increase of 37.5% in hospitalization cost of living and deceased patients. The economic impact of CAP-related hospital admissions justifies the need for better implementation of preventive measures.
Purpose of review:
Although most patients with community-acquired pneumonia (CAP) are treated as outpatients, the majority of data regarding CAP management is provided by hospitals, either from emergency department or inpatients. This was already noted in the first CAP guidelines, published in 1993, and the challenges regarding the outpatient management of CAP persist nowadays. These include the uncertainty of the initial diagnosis and risk stratification, the empirical choice of antibiotics, the overgrowing of antibiotic resistance bacteria and the relative scarcity of novel antibiotics.
Recent findings:
New molecular biology methods have changed the etiologic perspective of CAP, unveiling the role of virus. Diagnostic uncertainty may lead to antibiotic overuse and bacteria resistance. Novel antibiotics along with diagnostic improvement, related to the use of lung ultrasound and point-of-care biomarkers testing, may help to improve CAP treatment. Prevention, especially the use of antipneumococcal vaccine, is instrumental in reducing the burden of disease.
Summary:
Most of CAP cases are managed in the outpatient setting. However, most research is focused on hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in improving outcomes, as well as to the execution of stewardship programs that maintain current antibiotics, safeguard future ones and reinforce prevention.
Introduction:
Community-acquired pneumonia (CAP) remains a common and serious infection with wide variability in intra-hospital mortality.
Methods:
We performed a retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009.
Results:
The intra-hospital mortality rate was 20.4% with deaths in all age groups. The average age of deceased patients was 79.8 years, significantly higher than surviving patients with 71.3 years. Patients aged 50 or more presented a relative risk of death 4.4 times the risk of patients under this age group. Likewise, in patients aged 65 or more the risk of death was 3.2 times the risk of patients <65 years. Men died more at a younger age than women, the men who died were, on average, 4 years younger than women, 78.1 vs 82.1 years old. Relative risk of death in men was 17% higher than women after adjustment for year of admission and age.
Conclusion:
CAP remains an important cause of hospital mortality in all age groups.
We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.
Background:
Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.
Methods:
We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Findings:
Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.
Interpretation:
At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
Funding:
Bill & Melinda Gates Foundation.
Community-acquired pneumonia (CAP) causes considerable morbidity and mortality in adults, particularly in the elderly.
Structured searches of PubMed were conducted to identify up-to-date information on the incidence of CAP in adults in Europe, as well as data on lifestyle and medical risk factors for CAP.
The overall annual incidence of CAP in adults ranged between 1.07 to 1.2 per 1000 person-years and 1.54 to 1.7 per 1000 population and increased with age (14 per 1000 person-years in adults aged ≥65 years). Incidence was also higher in men than in women and in patients with chronic respiratory disease or HIV infection. Lifestyle factors associated with an increased risk of CAP included smoking, alcohol abuse, being underweight, having regular contact with children and poor dental hygiene. The presence of comorbid conditions, including chronic respiratory and cardiovascular diseases, cerebrovascular disease, Parkinson's disease, epilepsy, dementia, dysphagia, HIV or chronic renal or liver disease all increased the risk of CAP by twofold to fourfold.
A range of lifestyle factors and underlying medical conditions are associated with an increased risk of CAP in European adults. Understanding of the types of individual at greatest risk of CAP can help to ensure that interventions to reduce the risk of infection and burden of disease are targeted appropriately.
This report presents final 2008 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, state of residence, and cause of death.
Information reported on death certificates, which is completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision.
In 2008, a total of 2,471,984 deaths were reported in the United States. The age-adjusted death rate was 758.3 deaths per 100,000 standard population, a decrease of 0.2 percent from the 2007 rate and a record low figure. Life expectancy at birth rose 0.2 years, from 77.9 years in 2007 to a record high 78.1 years in 2008. The age-specific death rate increased for age group 85 years and over. Age-specific death rates decreased for age groups: less than 1 year, 5-14, 15-24, 25-34, 35-44, and 65-74 years. The age-specific death rates remained unchanged for age groups: 1-4, 45-54, 55-64, and 75-84 years. The 15 leading causes of death in 2008 remained the same as in 2007, but Chronic lower respiratory diseases and suicide increased in the ranking while stroke and septicemia decreased in the ranking. Stroke is the fourth leading cause of death in 2008 after more than five decades at number three in the ranking. Chronic lower respiratory diseases is the third leading cause of death for 2008. The infant mortality rate decreased 2.1 percent to a historically low value of 6.61 deaths per 1000 live births in 2008.
The decline of the age-adjusted death rate to a record low value for the United States and the increase in life expectancy to a record high value of 78.1 years are consistent with long-term trends in mortality.
Patients with Chronic Obstructive Pulmonary Disease (COPD) are at higher risk of developing Community-Acquired Pneumonia (CAP) than patients in the general population. However, no studies have been performed in general practice assessing longitudinal incidence rates for CAP in COPD patients or risk factors for pneumonia onset.
A cohort of COPD patients aged ≥ 45 years, was identified in the General Research Practice Database (GPRD) between 1996 and 2005, and annual and 10-year incidence rates of CAP evaluated. A nested case-control analysis was performed, comparing descriptors in COPD patients with and without CAP using conditional logistic regression generating odds ratios (OR) and 95% confidence intervals (CI).
The COPD cohort consisted of 40,414 adults. During the observation period, 3149 patients (8%) experienced CAP, producing an incidence rate of 22.4 (95% CI 21.7-23.2) per 1000 person years. 92% of patients with pneumonia diagnosis had suffered only one episode. Multivariate modelling of pneumonia descriptors in COPD indicate that age over 65 years was significantly associated with increased risk of CAP. Other independent risk factors associated with CAP were co-morbidities including congestive heart failure (OR 1.4, 95% CI 1.2-1.6), and dementia (OR 2.6, 95%CI 1.9-3.). Prior severe COPD exacerbations requiring hospitalization (OR 2.7, 95% CI 2.3-3.2) and severe COPD requiring home oxygen or nebulised therapy (OR 1.4, 95% CI 1.1-1.6) were also significantly associated with risk of CAP.
COPD patients presenting in general practice with specific co-morbidities, severe COPD, and age >65 years are at increased risk of CAP.
Information is limited on risk factors for community-acquired pneumonia (CAP) in free-living populations. We examined the associations of age, smoking status, body mass index (BMI), weight change during adulthood, physical activity, and alcohol intake with risk of CAP among men and women.
The study population included 26,429 men aged 44 to 79 years from the Health Professionals Follow-up Study and 78,062 women aged 27 to 44 years from the Nurses' Health Study II. Information was collected by biennial mailed questionnaires and the main outcome was physician-diagnosed incident pneumonia.
There were 290 cases among men (6 years of follow-up) and 305 cases among women (2 years of follow-up). Age, smoking status, BMI, physical activity, and alcohol intake were taken into account in the multivariate logistic regression model. There was a dose-response relation between aging and risk of CAP among men. Compared with never smokers, current smoking was associated with risk of CAP among men (relative risk, 1.46; 95% confidence interval, 1.00-2.14) and women (relative risk, 1.55; 95% confidence interval, 1.15-2.10). In addition, BMI was directly associated with an increased risk of CAP among women. Compared with the participants who maintained their weight during adulthood, the risks were nearly 2-fold higher among men and women who gained 40 lb or more (> or =18 kg). The risk of CAP decreased with increasing physical activity among women. We also found no significant relation between alcohol intake and risk of CAP among men and women.
Smoking and excessive weight gain are risk factors for CAP among men and women, and physical activity was inversely associated with risk of CAP only among women. The incidence of CAP could possibly be decreased by lifestyle factors.
The prevalence and care management of multiple (two or more) chronic conditions (MCC) are important public health concerns (1). Approximately 25% of U.S. adults have diagnoses of MCC (2). Care management of MCC presents a challenge to both patients and providers because of the substantial costs associated with treating more than one condition and the traditional care strategies that focus on single conditions as opposed to enhanced care coordination (3,4). Maintaining surveillance, targeting service delivery, and projecting resources are all important to meet this challenge, and these actions can be informed by identifying state and other regional variations in MCC prevalence (5,6). Data from the 2014 National Health Interview Survey (NHIS) were used to estimate prevalence of MCC (defined as two or more of 10 diagnosed chronic conditions) for each U.S. state and region by age and sex. Significant state and regional variation in MCC prevalence was found, with state-level estimates ranging from 19.0% in Colorado to 38.2% in Kentucky. MCC prevalence also varied by region, ranging from 21.4% in the Pacific region to 34.5% in the East South Central region. The prevalence of MCC was higher among women than among men within certain U.S. regions, and was higher in older persons in all regions. Such findings further the research and surveillance objectives stated in the U.S. Department of Health and Human Services (HHS) publication, Multiple Chronic Conditions: A Strategic Framework (1). Furthermore, geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources for MCC prevention activities.
Community-acquired pneumonia (CAP) is a major health problem with a very high prevalence and mortality. Mortality can reach 13% among hospitalized patients and nearly 50% in the long term (5 y). Similarly, acute coronary syndrome is a life-threatening condition for which clinical management has greatly improved because of effective protocols of prehospital care and evidence-based interventions in the hospital, within well-defined timescales. Unfortunately, CAP management cannot be compared with that of acute coronary syndrome in terms of risk stratification and action protocols. In fact, CAP continues to be the main cause of severe sepsis in hospitalized patients; early evaluation is fundamental, especially in the first 24 hours, when mortality is high. Current risk-stratification tools for CAP are designed primarily to predict mortality and identify low-risk patients, which is valuable for ambulatory treatment, whereas the detection of high-risk patients remains suboptimal. Recent attempts to improve predictive tools, with the development of new biomarkers and alternative scoring systems, are discussed.
Despite the remarkable advances in antibiotic therapies, diagnostic tools, prevention campaigns and intensive care, community-acquired pneumonia (CAP) is still among the primary causes of death worldwide, and there have been no significant changes in mortality in the last decades. The clinical and economic burden of CAP makes it a major public health problem, particularly for children and the elderly. This issue provides a clinical overview of CAP, focusing on epidemiology, economic burden, diagnosis, risk stratification, treatment, clinical management, and prevention. Particular attention is given to some aspects related to the clinical management of CAP, such as the microbial etiology and the available tools to achieve it, the usefulness of new and old biomarkers, and antimicrobial and other non-antibiotic adjunctive therapies. Possible scenarios in which pneumonia does not respond to treatment are also analyzed to improve clinical outcomes of CAP.
It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce. Mortality attributable to CAP varies widely between European countries and with the site of patient management. This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults. All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included. A total of 2606 records were used to identify primary studies. CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men. Streptococcus pneumoniae was the most common agent isolated. Mortality varied from <1% to 48% and was associated with advanced age, co-morbid conditions and CAP severity. Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was not related to mortality. CAP was associated with high rates of hospitalisation and length of hospital stay. The review showed that the clinical and economic burden of CAP in Europe is high. CAP has considerable long-term effects on quality of life, and long-term prognosis is worse in patients with pneumococcal pneumonia.
To better understand risk factors for pneumonia hospitalizations in people with impaired lung function.
We analyzed longitudinal data from participants in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). We limited our analysis to 20,375 participants aged 45 and older at baseline. We stratified the sample based on prebronchodilator baseline lung function data, according to modified GOLD criteria, including a "restrictive" category (FEV(1)/FVC>70% and FVC<80%). We defined "pneumonia" as a hospitalization with a pneumonia discharge diagnosis (ICD-9 codes 480-486) within 36 months. We used Cox proportional hazard models to determine pneumonia risk associated with COPD stage, adjusting for age, sex, race, smoking status and comorbid disease (diabetes mellitus or cardiovascular disease at the baseline examination).
Pneumonia hospitalization risk was associated with older age, male gender, comorbid conditions, smoking status, and level of lung function impairment. Overall, people with normal lung function had the lowest pneumonia hospitalization rate (1.5 per 1000 person-years) and those with GOLD stage 3 or 4 COPD had the highest rate (22.7 per 1000 person-years). After adjusting for other potential confounding factors, GOLD stages 3 or 4 and 2 COPD were associated with an increased risk of pneumonia (hazard ratio [HR] 5.65, 95% confidence interval [CI] 3.29, 9.67 and 2.25 (1.35, 3.75), respectively) relative to normal lung function.
COPD severity (GOLD stage) is an important and independent predictor of pneumonia hospitalizations in this cohort.
To investigate the prevalence of certain chronic conditions among the elderly and to estimate the relative risk for pneumonia associated with each condition.
Medical records of all inhabitants aged 60 years or more (4,175 persons) in one township (population 24,716) in Finland were reviewed, seeking 15 chronic conditions. Which patients had pneumonia in the same population was prospectively ascertained over a period of 3 years (185 patients).
Hypertension was the most frequent chronic condition (36.4%) in the study population. Other common conditions were heart disease (23.7%, with chronic compensated heart failure in 96.3% of these), other cardiovascular disease (13.1%), and diabetes (13.1%). The prevalence of any other condition was less than 5%. The following conditions were significantly more common among pneumonia patients than among control subjects: heart disease (38.4% versus 23.0%), lung disease (13.0% versus 3.8%), bronchial asthma (11.9% versus 3.1%), immunosuppressive therapy (2.7% versus 0.8%), alcoholism (2.2% versus 0.3%), and institutionalization (8.6% versus 3.9%). By multivariate logistic regression analysis, independent risk factors for pneumonia were alcoholism (relative risk [RR] = 9.0, confidence interval [CI] = 5.1 to 16.2), bronchial asthma (RR = 4.2, CI = 3.3 to 5.4), immunosuppressive therapy (RR = 3.1, CI = 1.9 to 5.1), lung disease (RR = 3.0, CI = 2.3 to 3.9), heart disease (RR = 1.9, CI = 1.7 to 2.3), institutionalization (RR = 1.8, CI = 1.4 to 2.4), and age (70 years or more versus 60 to 69 years; RR = 1.5, CI = 1.3 to 1.7). One third of the study population and 57% of the pneumonia patients had one or more of these risk factors. Diabetes, chronic pyelonephritis, and malignancies of sites other than the lungs were not associated with increased risk for pneumonia.
We found which elderly persons have an increased risk for pneumonia. Although the highest relative risk was associated with alcoholism, that condition was rare in this elderly population. Chronic obstructive lung diseases were more common and were also associated with a high relative risk. Heart disease had the highest public health impact because it was very common among the elderly and increased the risk of contracting pneumonia almost twofold; it also increased the risk of pneumonia-related death. These population-based data confirm and extend previous findings derived from selected patient groups and are useful for designing cost-effective pneumonia prevention programs.
Community-acquired pneumonia (CAP) is responsible for an average of 4.5 million visits annually to physicians' offices, emergency departments, and outpatient clinics. However, there have been few studies using national data on the costs of treating CAP. Without such data, it is difficult to assess whether new therapies and treatment strategies are needed to improve patient outcomes. We conducted a retrospective analysis based on national incidence data and paid claims data for patients treated for CAP to assess the frequency of services rendered and costs to the health-care system. Records were selected for the study based on a primary diagnosis of CAP according to the International Classification of Diseases, 9th Revision. Incidence data were derived from the National Health and Nutrition Examination Survey III. Medicare was the primary source of data for patients aged > or =65 years. Data from the National Healthcare Cost and Utilization Project, the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey were used to determine the cost of treating patients aged <65 years. We arrived at a total cost of 3.6 billion for treating patients aged <65 years. These calculations were based on the following: 1.1 million hospital discharges resulting in inpatient costs of 8.4 billion) for the 0.6 million patients aged > or =65 years and 8.4 billion) for the 0.5 million patients aged <65 years. The average hospital length of stay was 7.8 days with an average cost of 6042 for younger patients. Room and board represented the largest percentage of the average hospital bill for patients with CAP. Inpatient physician service costs were 192 million for the > or =65 and <65 groups, respectively. Based on 1.1 million outpatient office visits for those aged > or =65 years and 3.3 million visits for those aged <65, total outpatient costs were 266 million, respectively. Given the overwhelming cost burden for CAP in the hospital setting, any new therapy that allows patients to be treated in the outpatient setting could result in significant savings, especially for patients aged > or =65 years.
This report presents 1996 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described.
In 1996 a total of 2,314,690 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the state registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics, Centers for Disease Control and Prevention. Changes between 1995 and 1996 in death rates and differences in death rates across demographic groups in 1996 are tested for statistical significance. Unless otherwise specified reported differences are statistically significant.
The 1996 age-adjusted death rate for the United States decreased, reaching an all-time low of 491.6 deaths per 100,000 standard population, and life expectancy at birth increased by 0.3 years to 76.1 years, a record high. The 15 leading causes of death remained the same as in 1995, although there were changes in the ranking of some causes. Replacing homicide, septicemia became the 12th leading cause of death, and Alzheimer's disease moved from the 14th to the 13th leading cause. For the third consecutive year, the number of homicide deaths dropped, making it the 14th leading cause of death. Mortality declined for all age groups, including persons aged 85 and over. The largest decline in age-adjusted death rates among the leading causes of death was for Human immunodeficiency virus infection, which dropped 28.8 percent in 1996, compared with the previous year. The infant mortality rate declined by 4 percent to a record low of 7.3 infant deaths per 1,000 live births in 1996. Neonatal and postneonatal mortality rates declined for all races combined as well as for postneonatal white infants. Although not statistically significant, mortality rates for white and black neonatal infants and black postneonatal infants also declined.
The overall improvements in general mortality and life expectancy in 1996 continue the long-term downward trend in U.S. mortality. The drop in U.S. infant mortality continues the steady declines of the past four decades.
This report presents final 1998 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1998.
In 1998 a total of 2,337,256 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention.
The 1998 age-adjusted death rate for the United States decreased to an all-time low of 471.7 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.7 years. Of the 15 leading causes of death in 1998, the largest decline from the previous year--9.5 percent--in age-adjusted death rates was for Atherosclerosis (atherosclerosis). Human immunodeficiency virus (HIV) infection dropped from among the 15 leading causes for the first time since 1987. The age-adjusted death rate for firearm injuries decreased for the fifth consecutive year, declining 7.4 percent between 1997 and 1998. Among all causes of death, age-specific death rates rose for those under 1 year but declined for all other age groups, although the decline for children aged 1-4 years was not significant. The infant mortality rate was unchanged from 1997 at 7.2 infant deaths per 1,000 live births.
The overall improvements in general mortality and life expectancy in 1998 continue the long-term downward trend in U.S. mortality. Although unchanged from 1997, the trend in U.S. infant mortality is of steady declines over the past four decades.
The Economic Burden of Lung Disease
- J Gibson
- R Loddenkemper
- Y Sibille
The Economic Burden of Lung Disease. In: Gibson J, Loddenkemper R, Sibille Y, et al., eds. European Lung
White Book. Sheffield, European Respiratory Society/European Lung Foundation, 2013; pp. 16-27.
Deaths: Final Data for
- D Kenneth
- M A Kochanek
- L Sherry