Abstract
BackgroundWhile the incidence of pertussis has increased in adolescents and adults in recent years in the U.S., little is known about the incidence and economic burden of pertussis in older adults. This study provides evidence of the incidence of pertussis and direct medical charges associated with pertussis episodes of care (PEOCs) in adults aged 50 years and older in the U.S.MethodsPEOCs were divided into periods before and after the initial pertussis diagnosis was made (i.e., the index date) to capture any conditions immediately preceding the pertussis diagnosis that may have represented misdiagnoses and subsequent conditions that may have represented sequelae. Data were extracted from IMS's recently acquired SDI databases of longitudinal, patient-level practitioner claims and hospital operational billing records collected from private practitioners and hospitals, respectively, across the U.S. Patients 50 years and older with one or more ICD-9-CM diagnoses for pertussis/whooping cough and/or a laboratory test positive for Bordetella pertussis between 1/1/2006 and 10/31/2010 were eligible for study inclusion. Resource utilization and charges (i.e., unadjudicated claims) associated with the patient's physician and hospital care were analyzed. The nationally projected incidence of pertussis was estimated using a subsample of patients with the required data necessary for projection.ResultsEstimated incidence of diagnosed pertussis ranged from 2.1-4.6 cases per 100,000 people across the two age groups (50–64 and [greater than or equal to] 65) during the years 2006 to 2010. The analysis of charges included 5,748 patients [greater than or equal to] 50 years of age with pertussis. Average charges across the entire episode of care were $1,835 and $14,428 per patient in the outpatient and inpatient settings, respectively. The average number of outpatient (i.e., private practitioner) visits was 2 per patient in both the pre-index and post-index periods.ConclusionsIn the U.S., the incidence of diagnosed pertussis in adults 50 years and older has increased between 2006 and 2010. Healthcare utilization and charges associated with pertussis are substantial, suggesting the need for additional prevention and control strategies and a higher degree of clinical awareness on the part of health care providers. Additional research regarding pertussis in older populations is needed to substantiate these findings.
Highlights
While the incidence of pertussis has increased in adolescents and adults in recent years in the U.S, little is known about the incidence and economic burden of pertussis in older adults
Unweighted Sample The sample included 5,748 patients aged at least 50 years with pertussis, of whom 5,490 were observed in the private practitioner setting; 643 were observed in the hospital setting; and 385 were observed in both settings
Analysis of Variance (ANOVA) results indicated patient age was significantly different according to the type of first confirmation of pertussis (i.e., ICD-9 code 033.0, 033.9, 484.3 or a positive pertussis laboratory test) [F(3, 5744) = 47.42, p < .0001]
Summary
While the incidence of pertussis has increased in adolescents and adults in recent years in the U.S, little is known about the incidence and economic burden of pertussis in older adults. Before vaccines to prevent the disease were available, pertussis was a major cause of morbidity and mortality in U.S children. Following the universal recommendation of diphtheria, whole-cell pertussis and tetanus (DPT) vaccines in U.S children, a sharp decline in cases was observed for many decades. In recent decades reported pertussis cases have been steadily increasing in the U.S where pediatric vaccination rates remain high [2,3]. In the U.S, pertussis represents the least well controlled of all bacterial vaccine-preventable diseases for which universal childhood immunization is recommended [7,8]
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