Rates of hospitalization for community-acquired pneumonia among US adults: A systematic review

BackgroundCommunity-acquired pneumonia (CAP) is associated with significant disease burden in adults but has not been measured uniformly. Reconciling differences across studies is critical for understanding the true burden of CAP.MethodsWe performed a systematic literature review of the incidence of hospitalized CAP among US adults and described the impact of key study characteristics on these estimates.ResultsAfter review of 8361 articles as of January 31, 2019, we identified 28 studies with 41 unique estimates of hospitalized CAP incidence. Among adults ≥65 years of age, annual rates of hospitalized CAP ranged from 847 to 3500 per 100,000 persons with median = 1830. Rates were lower in studies that excluded patients with healthcare-associated (but community-onset) pneumonia (HCAP; median = 2003 vs 1286; P = 0.02) or immunocompromising conditions (median = 1895 vs 1409; P = 0.27) compared to those that did not. Rates of CAP were also lower in studies that used more restrictive criteria for diagnosing pneumonia (eg, pneumonia coded in any diagnosis position [median = 2270] vs pneumonia coded in the first position only [median = 1375] in studies of administrative claims; P = 0.02). For adults <65 years of age, rates of CAP were lower (range: 89 to 1138 per 100,000; median = 199).ConclusionsCAP causes a significant disease burden among adults, particularly among those ≥65 years of age. Commonly-applied exclusion criteria (eg, persons with HCAP or immunocompromising conditions) or restrictive case definitions (eg, only including pneumonias coded in the primary diagnosis position) have led to systematic underestimation of CAP incidence in many previous studies. In studies that did not apply these restrictive criteria, the rate of hospitalization was approximately 2000 per 100,000 annually. Understanding the true burden of adult CAP is critical for highlighting the ongoing need for expanded prevention programs, including vaccination.     

Variation in management of community-acquired pneumonia requiring admission to Alberta,Canada hospitals

Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay.     

The effect of rotavirus immunization on rotavirus gastroenteritis hospitalization rates in military dependents

We conducted a retrospective review of all U.S. military dependents less than 5 years old hospitalized with rotavirus-associated gastroenteritis from July 2003 to June 2009. The two post-vaccine seasons showed a significant reduction of 62.4% (95% CI, 58.6-65.8, P < 0.001) in rotavirus gastroenteritis hospitalization rate compared to the three pre-vaccine seasons. Infants less than 12 months old showed the greatest reduction in incidence at 75.3%. A substantial decrease was also seen in unvaccinated children as well. Vaccine efficacy against hospitalization was 86.0% (95% CI, 77.7-91.3) after just a single dose. The overwhelming majority of children hospitalized for rotavirus since the introduction of the vaccine (ranging from 91.8 to 100% per season) had not received any of the rotavirus vaccine series.     

广州市中老年社区获得性肺炎住院患者特征及住院时长的影响因素研究

目的 分析广州市中老年社区获得性肺炎住院患者的流行病学特征、基础疾病及诊治情况,并探讨影响其住院时长的因素。方法 收集广州市6家综合三甲医院≥40岁中老年社区获得性肺炎患者的病历资料,采用回顾性病例分析其流行病学特征、基础疾病及诊治情况,通过logistic多元回归模型探讨患者住院时长的影响因素。结果 共纳入6 231例中老年社区获得性肺炎患者,平均年龄（69.87±12.32）岁,其中男性3 583例（57.5%）,基础疾病以高血压（31.8%）、糖尿病（16.6%）、慢性阻塞性肺疾病（11.3%）较多。病原学检查结果显示细菌（25.4%）及真菌（14.9%）感染较多,97.7%患者接受了抗生素治疗。多因素非条件logistic回归分析结果发现,年龄（OR=1.005,95%CI：1.001～1.009）、吸烟史（OR=1.292,95%CI：1.159～1.441）、肿瘤（OR=1.217,95%CI：1.022～1.449）、充血性心力衰竭（OR=1.323,95%CI：1.076～1.626）、使用糖皮质激素（OR=1.744,95%CI：1.545～1.969）及转入ICU（OR=2.724,95%CI：2.031～3.654）为广州市中老年社区获得性肺炎患者住院时长的影响因素。结论 广州市中老年社区获得性肺炎患者常有多种基础疾病,以高血压、糖尿病等较为常见,年龄、吸烟史、肿瘤、充血性心力衰竭、使用糖皮质激素及转入ICU等为患者住院时长的影响因素。     

Performance-based physician reimbursement and influenza immunization rates in the elderly

Objective: To investigate the effect of performance-based financial incentives on the influenza immunization rate in primary care physicians' offices.Design: Randomized controlled trial during the 1991 influenza immunization season.Setting: Rochester, New York, and surrounding Monroe County during the Medicare Influenza Vaccine Demonstration Project.Participants: A total of 54 solo or group practices that had participated in the 1990 Medicare Demonstration Project.Interventions: All physicians in participating practices agreed to enumerate their ambulatory patients aged 65 or older who had been seen during the 1990 or 1991 calendar years, and to track the immunization rate on a weekly basis using a specially designed poster from September 1991 to January 1, 1992. Additionally, physicians agreed to be randomized, by practice group, to the control group or to the incentive group, which could receive an additional $.80 per shot or $1.60 per shot if an immunization rate of 70% or 85%, respectively, was attained.Measurements: The main outcome measures are the 1991 immunization rate and the improvement in immunization rate from the 1990 to 1991 influenza seasons for each group practice.Results: For practices in the incentive group, the mean immunization rate was 68.6% (SD 16.6%) compared with 62.7% (SD 18.0%) in the control group practices (P = .22). The median practice-specific improvement in immunization rate was +10.3% in the incentive group compared with +3.5% in the control group (P = .03).Conclusions: Despite high background immunization rates, this modest financial incentive was responsible for ∼7% increase in immunization rate among the ambulatory elderly.     

Association of vaccine hesitancy and immunization coverage rates in the European Union

While previous studies have validated vaccine hesitancy scales with uptake behavior at the individual level, the conditions under which aggregated survey data are useful are less clear. We show that vaccine public opinion data aggregated at the subnational level can serve as a valid indicator of aggregate vaccine behaviour. We use a public opinion survey (Eurobarometer EB 91.2) with data on vaccine hesitancy for the EU in 2019. We link this information to (subnational) regional immunization coverage rates for childhood vaccines – DTP3, MCV1, and MCV2 -- obtained from the WHO for 2019. We conduct multilevel regression analyses with data for 177 regions in 20 countries. Given the variation in vaccine hesitancy and immunization rates between countries and within countries, we affirm the valuable role that surveys can play as a public health surveillance tool when it comes to vaccine behavior. We find statistically significantly lower regional vaccine immunization rates in regions where vaccine hesitancy is more pronounced. Our results suggest that different uptake rates across subnational regions are due, at least in part, to differences in attitudes towards vaccines and vaccination. The results are robust to several alternative specifications.     

Policies and practices for improving influenza immunization rates among healthcare workers.

OBJECTIVE: To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina. METHODS: Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact. RESULTS: Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included "fear of side effects" and "perceived ineffectiveness of the flu vaccine." Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact. CONCLUSION: A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.     

The impact of the universal infant varicella immunization strategy on Canadian varicella-related hospitalization rates

Introduction

Varicella vaccine was introduced to the infant immunization schedule in each province or territory between 2000 and 2007 as a result of the Canadian Immunization Strategy. The impact of vaccinating children against this disease is potentially far reaching, as immunization may also benefit those segments of the population not immunized. The objective of this paper is to examine the effects of varicella vaccine on related hospitalizations across the entire Canadian population.

Methods

This study is an ecological study using annual hospitalization rates in all ten provinces between 1990 and 2010.

Results

There were decreased varicella-related hospitalization rates for all ages across Canada following the introduction of varicella vaccination programs. The majority of changes in hospitalization rates were greater than 70% across all ages less than 40. Statistically significant declines in hospitalization were found for children aged 1–4 (ranges from 65 to 93%), and children less than 1 (ranges from 48 to 100%). Adults aged 20–39 and 40–59 also experienced statistically significant declines (55–100%, and 39–76% respectively).

Conclusion

Results suggest that decreased circulation of varicella appears to significantly contribute to declines in varicella-related hospitalizations for infants <1, as well as adults aged 20–39.     

Survey of national immunization programs and vaccine coverage rates in Asia Pacific countries

Children in the Asia Pacific region are still suffering from certain vaccine-preventable diseases. The current study surveyed the national immunization programs and vaccine uptake of traditional and newly developed vaccines in 12 countries in this area. The results showed children in most countries were well protected from conventional vaccine-preventable diseases, while immunization programs for certain diseases such as poliovirus or measles should be strengthened in certain countries. Protection against pneumococcus, rotavirus, and human papillomavirus infections were obviously inadequate in most of the countries in the region. Promoting coverage of newly developed vaccines will benefit a great number of children in this area.     

The relationship between supply and hospitalization rates for mental illness and substance use disorders

This study investigated the extent to which mental illness and substance use hospitalization rates were related to the supply of psychiatric treatment services. Supply variables, notably the per capita rate of psychiatrists, primary care physicians, and specialty units, were strongly related to mental illness and substance use hospitalization rates to acute care hospitals across 114 small geographic areas in Iowa. The supply of outpatient services was not related to hospitalization rates. The need to study the reliability of patient assessment processes, refine guidelines and admissions criteria, and understand the contributions of supply variables to hospitalization rates are indicated by these results. A conceptual model is offered within which the dynamic cycle from patient functioning to service delivery may be framed.     

Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78.

In this study, excess rates of pneumonia and influenza (P&I) associated hospitalization during influenza A epidemics which occurred in the United States between 1970-78 were computed utilizing unpublished data from the National Hospital Discharge Survey (NHDS). Excesses occurred at rates of 35, 93, and 370 per 100,000 persons per epidemic for age groups 15-44, 45-64, and 65+ years. There was no evidence of a persisting excess or a compensatory decline in P&I hospitalization during post-epidemic months. An average excess of about 172,000 hospitalizations per epidemic at a cost in excess of $300 million was computed. The study quantifies a major impact of epidemic influenza upon health and health services, much of which may be preventable, and illustrates an important use of unpublished data contained in the NHDS.     

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the child's parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.     

Improving influenza immunization rates among healthcare workers caring for high-risk pediatric patients.

OBJECTIVE: To assess influenza vaccination rates of healthcare workers (HCWs) in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and oncology units in Pediatric Prevention Network (PPN) hospitals. PARTICIPANTS: Infection control practitioners and HCWs in NICUs, PICUs, and oncology units. METHODS: In November 2000, posters, electronic copies of a slide presentation, and an influenza fact sheet were distributed to 32 of 76 PPN hospitals. In January 2001, a survey was distributed to PPN hospital participants to obtain information about the immunization campaigns. On February 7, 2001, a survey of influenza immunization was conducted among HCWs in NICU, PICU, and oncology units at participating hospitals. RESULTS: Infection control practitioners from 19 (25%) of the 76 PPN hospitals completed the surveys. The median influenza immunization rate was 43% (range, 12% to 63%), with 7 hospitals exceeding 50%. HCWs (n = 1123) at 15 PPN hospitals completed a survey; 53% of HCWs reported receiving influenza immunization. Immunization rates varied by work site: 52% in NICUs and PICUs compared with 60% in oncology units. Mobile carts and PPN educational fact cards were associated with higher rates among these subpopulations (P < .001) (361 [63%] of 575 vs 236 [44%] of 541 for mobile carts; 378 [60%] of 633 vs 219 [45%] of 483 for fact cards). CONCLUSION: Despite delayed distribution of influenza vaccine during the 2000-2001 season, immunization rates at 7 hospitals and among HCWs in high-risk units exceeded the National Association of Children's Hospitals and Related Institutions goal of 50%.     

The burden of community-acquired pneumonia in Spain.

BACKGROUND: Community-acquired pneumonia accounts for a large number of hospitalizations and deaths in developed countries. METHODS: Data for Spain were obtained from the national surveillance system for hospital data and comprises all hospital discharges for pneumonia reported during a two-year period. RESULTS: The annual incidence of hospitalization for pneumonia was 160 per 100,000 population. Incidence of hospitalization, mortality, average length of stay and case-mortality rate were higher in persons > or = 65 years of age. The annual cost of these hospitalizations was 115 million ECUs (1 ECU = 1.19 US Dollars). CONCLUSION: Community-acquired pneumonia accounts for 53,000 hospitalizations per year in Spain, and this imposes a large economic cost on the National Health-care System.     

C-反应蛋白在老年社区获得性肺炎与医院获得性肺炎中的比较研究

目的 分析血清C-反应蛋白(CRP)水平在老年不同病原菌肺部感染中的诊断作用.方法 对医院的98例社区获得性肺炎(CAP)、128例医院获得性肺炎(HAP)住院患者血中CRP、白细胞(WBC)、中性粒细胞(N)进行测定,并对痰标本进行病原菌分离鉴定.结果 CAP、HAP患者血中CRP水平分别为(79.8±16.2) mg/L和(46.4±8.4)mg/L,两组间差异有统计学意义(P＜0.01),而WBC、N则无明显差异;CAP患者病原菌检出率为43.88％,以革兰阳性球菌为主占27.55％,HAP患者病原菌检出率为63.28％,以革兰阴性杆菌为主占56.25％,两组患者的病原菌检出率、构成比差异均有统计学意义(P＜0.01).结论 CAP患者CRP水平显著高于HAP患者,两组患者感染的病原菌存在显著性差异,测定CRP水平有助于区分两组患者,指导临床合理选用抗菌药物.