Abstract
Community-acquired lower respiratory tract infections (LRTI) and pneumonia (CAP) are common causes of morbidity and mortality among those aged ≥65 years; a growing population in many countries. Detailed incidence estimates for these infections among older adults in the United Kingdom (UK) are lacking. We used electronic general practice records from the Clinical Practice Research Data link, linked to Hospital Episode Statistics inpatient data, to estimate incidence of community-acquired LRTI and CAP among UK older adults between April 1997-March 2011, by age, sex, region and deprivation quintile. Levels of antibiotic prescribing were also assessed. LRTI incidence increased with fluctuations over time, was higher in men than women aged ≥70 and increased with age from 92.21 episodes/1000 person-years (65-69 years) to 187.91/1000 (85-89 years). CAP incidence increased more markedly with age, from 2.81 to 21.81 episodes/1000 person-years respectively, and was higher among men. For both infection groups, increases over time were attenuated after age-standardisation, indicating that these rises were largely due to population aging. Rates among those in the most deprived quintile were around 70% higher than the least deprived and were generally higher in the North of England. GP antibiotic prescribing rates were high for LRTI but lower for CAP (mostly due to immediate hospitalisation). This is the first study to provide long-term detailed incidence estimates of community-acquired LRTI and CAP in UK older individuals, taking person-time at risk into account. The summary incidence commonly presented for the ≥65 age group considerably underestimates LRTI/CAP rates, particularly among older individuals within this group. Our methodology and findings are likely to be highly relevant to health planners and researchers in other countries with aging populations.
Highlights
Pneumonia and lower respiratory tract infections (LRTI) are major causes of morbidity and mortality among those aged 65 years and over in the United Kingdom (UK) and other European countries [1,2,3]
There is a paucity of information for this important and growing subsection of the population; it is essential that their LRTI burden is better understood to enable planning and provision of health care
We have shown that the incidence of LRTI and Community-acquired pneumonia (CAP) increases markedly with age within this older population
Summary
Pneumonia and lower respiratory tract infections (LRTI) are major causes of morbidity and mortality among those aged 65 years and over in the UK and other European countries [1,2,3]. The need has been highlighted for new population-based studies of the incidence of these infections among older adults in different European locations [6]. There are few longitudinal studies on the burden of these infections amongst older adults in the UK. This is a disparate group, including people working full-time and those that require round-the-clock care. Partly due to different age categorisations and methods used [1,7,8], and community- and hospital-acquired infections are rarely differentiated. The extent of antibiotic prescribing in general practice for both LRTI and CAP among older adults needs ongoing assessment
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