Marked Reduction in 30-Day Mortality Among Elderly Patients with Community-acquired Pneumonia - 19/08/11
, Marcelo Coca-Perraillon, MA b, Barrett T. Kitch, MD, MPH c, d, David M. Cutler, PhD b, e
Requests for reprints should be addressed to Gregory W. Ruhnke, MD, MS, MPH, Section of Hospital Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5000, Chicago, IL 60637Abstract |
Background |
Community-acquired pneumonia is the most common infectious cause of death in the US. Over the last 2 decades, patient characteristics and clinical care have changed. To understand the impact of these changes, we quantified incidence and mortality trends among elderly adults.
Methods |
We used Medicare claims to identify episodes of pneumonia, based on a validated combination of diagnosis codes. Comorbidities were ascertained using the diagnosis codes located on a 1-year look back. Trends in patient characteristics and site of care were compared. The association between year of pneumonia episode and 30-day mortality was then evaluated by logistic regression, with adjustment for age, sex, and comorbidities.
Results |
We identified 2,654,955 cases of pneumonia from 1987-2005. During this period, the proportion treated as inpatients decreased, the proportion aged ≥80 years increased, and the frequency of many comorbidities rose. Adjusted incidence increased to 3096 episodes per 100,000 population in 1999, with some decrease thereafter. Age/sex-adjusted mortality decreased from 13.5% to 9.7%, a relative reduction of 28.1%. Compared with 1987, the risk of mortality decreased through 2005 (adjusted odds ratio, 0.46; 95% confidence interval, 0.44-0.47). This result was robust to a restriction on comorbid diagnoses assessing for the results' sensitivity to increased coding.
Conclusions |
These findings show a marked mortality reduction over time in community-acquired pneumonia patients. We hypothesize that increased pneumococcal and influenza vaccination rates as well as wider use of guideline-concordant antibiotics explain a large portion of this trend. © 2011 Elsevier Inc. All rights reserved.
Le texte complet de cet article est disponible en PDF.Keywords : Community-acquired pneumonia, Mortality, Trends
Plan
| Funding: This work was supported by unrestricted grants P01 AG31098, P30 AG12810, and P01AG005842 from the National Institute on Aging. It also was supported by an institutional Ruth L. Kirschstein National Research Service Award (T32 HP11001) from the Health Resources and Services Administration of the Department of Health and Human Services, the Division of General Internal Medicine at the Massachusetts General Hospital, and grant F32 HS016948-01 from the Agency for Healthcare Research and Quality. The supporters had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. |
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| Conflict of Interest: The authors confirm the absence of potential conflicts of interest, financial or otherwise. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. Dr. Ruhnke had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. |
Vol 124 - N° 2
P. 171 - février 2011 Retour au numéro
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