Abstract
BackgroundThe incidence of pneumonia in Korea started to increase in the 1990’s after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. This study was performed to examine geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea.MethodsData were acquired from the inpatient claims of the 2015 period of the National Health Insurance Service. The age- and sex-standardized hospitalization rates for bacterial pneumonia were calculated for three age groups. Geographic variation was measured with the coefficient of variation, the ratio of the 90th to the 10th percentile of the distribution of rates, and the systematic component of variation. Considering the results of Moran’s I statistic which suggested spatial autocorrelation, we estimated spatial regression models using spatial error models.ResultsThe hospitalization rate for bacterial pneumonia was 79.1 per 10,000 population, and the rate was the highest in the age group 0–14 at 325.3, and it was 161.5 among the elderly. The geographic variation statistics showed high variation with the coefficient variation at 0.6. The deprivation score showed positive associations, and the number of primary care physicians had a negative association with the hospitalization rates across all age groups but the age group 0–14. The number of beds in hospitals with less than 300 beds had a positive association with the hospitalization rates for bacterial pneumonia, and the impact was the strongest in the age group 0–14.ConclusionsThe present study shows that pneumonia can be a major public health issue even in a developed country. Socioeconomic conditions can still be a concern for pneumonia in developed countries, and the role of primary care physicians in preventing hospitalization for bacterial pneumonia needs to be recognized. Most of all, the strong impact of hospital beds on the hospitalization rates for pneumonia, especially for the children, should be addressed. High disease burden of pneumonia in Korea can partly be attributable to oversupply of hospital beds. These factors should be taken into consideration in establishing policy measures for the rise in pneumonia.
Highlights
The incidence of pneumonia in Korea started to increase in the 1990’s after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high
The deprivation score showed positive associations, and the number of primary care physicians had a negative association with the hospitalization rates across all age groups except for the age group 0–14, where no significant association was shown
The hospitalization rate for bacterial pneumonia in Korea is very high compared with other countries [8, 31,32,33], and the proportion of pneumonia as a cause of hospitalization in Korea is very high compared with other countries [34,35,36,37]
Summary
The incidence of pneumonia in Korea started to increase in the 1990’s after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. Since the mid 1990’s, deaths due to pneumonia have continued to increase, which moved pneumonia from the tenth to the fourth leading cause of deaths during the last 10 year period [14] This phenomenon can be partly attributed to the change in the demographic structure which involved an increase in the elderly population. During the last 20 years, the mortality rate due to pneumonia among those 65 and over increased around five-fold [12] while the proportion of the population of them increased about 40% points [15, 16] This suggests that there are factors that increased the incidence of pneumonia regardless of the change in the population structure
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