Abstract
Pneumonia is a leading cause of death in New York City (NYC). We identified spatial clusters of pneumonia-associated hospitalisation for persons residing in NYC, aged ⩾18 years during 2010-2014. We detected pneumonia-associated hospitalisations using an all-payer inpatient dataset. Using geostatistical semivariogram modelling, local Moran's I cluster analyses and χ2 tests, we characterised differences between 'hot spots' and 'cold spots' for pneumonia-associated hospitalisations. During 2010-2014, there were 141 730 pneumonia-associated hospitalisations across 188 NYC neighbourhoods, of which 43.5% (N = 61 712) were sub-classified as severe. Hot spots of pneumonia-associated hospitalisation spanned 26 neighbourhoods in the Bronx, Manhattan and Staten Island, whereas cold spots were found in lower Manhattan and northeastern Queens. We identified hot spots of severe pneumonia-associated hospitalisation in the northern Bronx and the northern tip of Staten Island. For severe pneumonia-associated hospitalisations, hot-spot patients were of lower mean age and a greater proportion identified as non-Hispanic Black compared with cold spot patients; additionally, hot-spot patients had a longer hospital stay and a greater proportion experienced in-hospital death compared with cold-spot patients. Pneumonia prevention efforts within NYC should consider examining the reasons for higher rates in hot-spot neighbourhoods, and focus interventions towards the Bronx, northern Manhattan and Staten Island.
Highlights
Pneumonia is a clinical syndrome characterised by infection of the lungs
The majority of overall pneumonia-associated hospitalisations were caused by community-acquired pneumonia (CAP) (N = 88 420; 62.4%), followed by healthcare-associated pneumonia (HCAP) (N = 38 576; 27.2%), hospital-acquired pneumonia (HAP) (N = 12 292; 8.7%) and ventilator-associated pneumonia (VAP) (N = 2442; 1.7%)
We found distinct spatial patterns in the rates of overall pneumonia-associated hospitalisation, severe pneumonia-associated hospitalisation and CAP-associated hospitalisation for New York City (NYC) during 2010–2014
Summary
Pneumonia is a clinical syndrome characterised by infection of the lungs. Common aetiologic agents include Streptococcus pneumoniae and influenza virus, with clinical manifestations ranging from mild symptoms to severe illness and death [1]. Infections can occur within the community setting or in association with healthcare settings [2]. Together, ‘pneumonia and influenza’ rank as the third leading cause of death in New York City (NYC), with most deaths attributed to an underlying cause of pneumonia, not influenza [3]. During 2010–2014, 54.3% of pneumonia-associated hospitalisations among adults in NYC were due to community-acquired pneumonia (CAP), 30.2% to healthcare-associated pneumonia (HCAP), 14.0% to hospital-acquired pneumonia (HAP) and the remaining 1.6% to ventilator-associated pneumonia (VAP) [4]. While the distribution of each setting of acquisition is known to vary across the five boroughs of NYC, the distribution within each borough has not yet been assessed
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