Pneumonia Hospitalization Rates Research Articles

64 Respiratory outcomes by five years of age among children born preterm: A population-based study using health services data

Abstract Background While neonatal care advancements have led to increased survival of preterm infants, many experience ongoing respiratory complications. Objectives Healthcare administrative data offers a comprehensive measure of neonatal outcomes. Our study used population-based data to describe rates of healthcare contacts for respiratory disease among children born preterm. Design/Methods A retrospective cohort of infants born in British Columbia between 2004-2014 was identified using a provincial birth registry. By linking to population-based healthcare data, we captured population demographics, birth data, and healthcare visits for respiratory causes [outpatient visits, hospitalizations, and intensive care (ICU) admissions] up to 5 years of age. The rate of healthcare visits due to asthma, bronchiolitis, and pneumonia were compared between preterm (22-36 weeks) and term/post-date infants (37-44 weeks GA) using Poisson regression. Results Children born at term (n=413,140) were compared to children born at 34-36 week GA (n=33,227), 28-33 week GA (n=8362), and 22-27 week GA (n=1231). Compared to term infants, rates of hospitalizations and ICU admission for all respiratory causes were higher among children born preterm. Children born 22-27 weeks GA had the highest rates of hospitalization for asthma [rate ratio (RR) 9.4, 95% CI 7.9-11.1], bronchiolitis (RR 10.5, 95% CI 9.3-11.8) and pneumonia (RR 15.9, 95% CI 14.3-17.7). Rates of ICU admission for asthma (RR 27.1, 95% CI 17.2-40.4) and pneumonia (RR 58.1, 95% CI 46.6-71.7) were highest among 22-27 week GA infants. Increased rates persist among children born 34-36 weeks GA, with higher rates of hospitalization for asthma (RR 1.8, 95% CI 1.6-1.9), bronchiolitis (RR 2.1, 95% CI 2.0-2.2), and pneumonia (RR 1.8, 95% CI 1.7-2.0) compared to term infants. Conclusion Preterm infants experience significantly higher rates of outpatient visits, hospitalizations, and ICU admissions for respiratory disease compared to term infants. Healthcare utilization, including ICU admissions, increased with decreasing gestational age. Of note, increased rates of respiratory disease were also found among infants born 34-36 weeks GA. Our study is the first to use population based data to describe rates of healthcare contacts for respiratory disease among preterm infants, providing insight to long-term respiratory disease burden.

Prognostic clinical decision support for pneumonia in the emergency department: A randomized trial.

Hospitalization rates for childhood pneumonia vary widely. Risk-based clinical decision support (CDS) interventions may reduce unwarranted variation. We conducted a pragmatic randomized trial in two US pediatric emergency departments(EDs) comparing electronic health record (EHR)-integrated prognostic CDS versus usual care for promoting appropriate ED disposition in children (<18 years) with pneumonia. Encounters were randomized 1:1 to usual care versus custom CDS featuring a validated pneumonia severity score predicting risk for severe in-hospital outcomes. Clinicians retained full decision-making authority. The primary outcome was inappropriate ED disposition, defined as early transition to lower- or higher-level care. Safety and implementation outcomes were also evaluated. The study enrolled 536 encounters (269 usual care and 267 CDS). Baseline characteristics were similar across arms. Inappropriate disposition occurred in 3% of usual care encounters and 2% of CDS encounters (adjusted odds ratio: 0.99, 95% confidence interval: [0.32, 2.95]). Length of stay was also similar and adverse safety outcomes were uncommon in both arms. The tool's custom user interface and content were viewed as strengths by surveyed clinicians (>70% satisfied). Implementation barriers include intrinsic (e.g., reaching the right person at the right time) and extrinsic factors (i.e., global pandemic). EHR-based prognostic CDS did not improve ED disposition decisions for children with pneumonia. Although the intervention's content was favorably received, low subject accrual and workflow integration problems likely limited effectiveness.Clinical Trials Registration: NCT06033079.

Association between bed supply and pneumonia hospitalization according to hospital types in Korea

Abstract Background An ecological study was conducted to determine the causes of regional differences in hospitalized pneumonia incidence in Korea. We evaluated the association between regional bed capacity and pneumonia hospitalization rates, and the interaction of hospital type. Methods Variables of hospitalized pneumonia patients (n = 2,226,243) aged 19 years from 2015 to 2020, prior to the COVID-19 pandemic, were extracted from the Korean National Insurance database. Age-standardized pneumonia hospitalization rates per 10,000 population by region and year were calculated. Multilevel linear regression was conducted to assess the association between the regional number of beds by hospital type and pneumonia hospitalization rates. The multilevel analysis was stratified by length of stay (LOS) and whether recommended clinical practices for pneumonia treatment were performed during hospitalization. Results Pneumonia hospitalization rates were highest in the Gwangju metropolitan city. The excessive pneumonia hospitalization rate in Gwangju occurred mainly in primary care (PC) and nursing care (NC) hospitals. A significant positive association between regional number of bed supply and pneumonia hospitalization rates (p-value=0.0157) was found. Interaction effect of hospital type and regional bed number supply was statistically significant (p-value&amp;lt;0.001). Positive association between regional bed supply and hospitalization rates was prominent in low grade hospitals, such as PC or NC hospital, and with the poor adequacy of pneumonia care, including long LOS and without recommended clinical practices. Conclusions The results suggest that while public health benefits can be expected from increased regional bed availability, there may be unexpected harms associated with supplier-induced demand for hospitalization, mostly in inferior hospitals. Therefore, hospital type and quality of medical care also should be considered in the process of expanding bed capacity in a region. Key messages • Regional difference of pneumonia hospitalization rates was associated with hospital bed capacity. • Supplier induced hospitalization of pneumonia occurred mainly in inferior type of hospital.

The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study

BackgroundOlder adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU.MethodsThis is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes.ResultsA total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08–2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03–5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00–5.31, p = 0.049). The association lost significance after adjustment.ConclusionsThe increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.

Pneumonia in Children under 5 Years: Temporal Trends and Spatial Patterns of Hospitalizations in Brazil.

This study aimed to identify temporal and spatial patterns in the distribution of hospitalization rates for pneumonia in children under 5 years in Brazil. An ecological study was developed using data from the Unified Health System of hospitalizations for pneumonia in children under 5 years in Brazil from 2000 to 2019. Hospitalization rates per 1,000 children were calculated and Joinpoint Regression analyzed the temporal trends. Different spatial analysis techniques were performed. Annual rates of 25 hospitalizations per 1,000 children were observed in 2000 and of 13.83 per 1,000 children in 2019, with a significant downward trend for the country (annual percentage change = -3.4%; 95% confidence interval: -3.8 to -3.0) and for the regions. There was weak spatial autocorrelation; however, there were regions with high rates of hospitalization in the south region and clusters of low rates in the northeast and southeast. Clusters of areas with high hospitalization rates were observed in areas of favorable socioeconomic conditions and provision of health services in the interior of southern Brazil. There is a decreasing trend in hospitalizations for pneumonia in general; however, there are clusters of high rates in the south of Brazil.

Burden of Hospitalizations Related to Pneumococcal Infection in Spain (2016-2020).

Pneumococcal infection strongly contributes to morbidity and mortality in Spain. A total of 253,899 hospitalizations related to pneumococcal infection occurred from 2016 to 2020. Fifty-eight percent were men, the mean age was 67 years old, and the average length of hospitalization was 12.72 days. The annual hospitalization rate was 10.84 hospitalizations per 10,000 population, increasing significantly with age, reaching 65.75 per 10,000 population in those aged &gt;85 years. The hospitalization rates for pneumococcal pneumonia, sepsis, and meningitis were 2.91, 0.12, and 0.08 hospitalizations per 10,000, respectively, and reached the highest value in those aged &gt;85 for pneumococcal pneumonia and sepsis, with 22.29 and 0.71 hospitalizations per 10,000, respectively, and in children up to 1 year old for pneumococcal meningitis, with 0.33 hospitalizations per 10,000. The total number of deaths during the study period was 35,716, with a case-fatality rate of 14.07%. For pneumococcal pneumonia, sepsis, and meningitis, the case-fatality rates were 8.47%, 23.71%, and 9.99%, respectively. The case-fatality rate increased with age and did not vary by sex. The annual cost of these hospitalizations was more than EUR 359 million. There is therefore a high burden of disease and mortality caused by pneumococcal infection in our country, especially in elderly individuals.

Pneumonia hospitalizations and mortality in children 3 – 24-month-old in Nigeria from 2013 to 2020: Impact of pneumococcal conjugate vaccine ten valent (PHiD-CV-10)

ABSTRACT Pneumococcal conjugate vaccine ten valent (PCV 10) was introduced into Nigeria in three phases. Phase 3 introduction started in August 2016. However, its impact on pneumonia admissions and mortality among vaccinated Nigerian children has not been determined. Data in the period before PCV-10 introduction (3 August 2013–2 August 2016), and after (3 August 2017–2 August 2020) were retrospectively extracted from the medical charts of eligible patients aged 3–24 months with hospitalized radiological pneumonia at the University College Hospital (UCH), Ibadan; National Hospital (NH), Abuja; and Federal Teaching Hospital (FTH), Gombe, allowing for an intervening period of 1 year. Proportions of the patients with hospitalized pneumonia and case fatality rates were determined during both periods. The results were compared using z-test, multiple logistic regression analysis and p < .05 was considered significant. Adjusted pneumonia hospitalization rates between the two periods increased at the NH Abuja (10.7% vs 14.6%); decreased at the UCH, Ibadan (8.7% vs 6.9%); and decreased at the FTH, Gombe (28.5% vs 18.9%). Case fatality rates decreased across all the sites during the post-PCV introduction period: NH Abuja, from 6.6% to 4.4% (p = .106); FTH, Gombe, 11.7% to 7.7% (p = .477); and UCH, Ibadan, 2.0% to 0% (p = .045); but only significant at Ibadan. Overall, proportion of hospitalized pneumonia cases decreased after 3 years of PCV 10 introduction into the National Immunization Programme in Nigeria. The case fatality rate during post-PCV 10 introduction decreased at all the three sites, but this difference was significant at the UCH, Ibadan.

The impact of pneumococcal conjugate vaccine on the prevalence and severity of hospitalizations for pneumonia in children.

Pneumococcal conjugate vaccines (PCV) were introduced into the Israeli national immunization plan starting with the heptavalent PCV7 in 2009 and then PCV13 in the late 2010. The objective of this study was to determine the vaccines' impact on hospitalization rates for community-acquired pneumonia on the severity of the pneumonia episodes and upon pneumococcal serotype distribution. We retrospectively reviewed all children hospitalized in our institution with pneumonia, aged between 1 and 16years, between the years 2006 and 2015. Demographic, clinical, and laboratory data between three time periods: pre-PCV, PCV7, and PCV13, were compared. During the study period, 1375 children were hospitalized with pneumonia. A gradual decline in hospitalization rates due to pneumonia was observed starting in 2006 in the pre-PCV period and continued until after the introduction of PCV13. A similar trend was observed in pneumonias with a culture positive for S. pneumoniae. Pleural effusion was observed in 24% of all pneumonias, and this percentage was stable throughout the study period. The average age at hospitalization increased during the study period, as did the average duration of hospital stay. Pneumococcal serotypes included in the vaccine were isolated less frequently during the study and non-vaccine serotypes tended to appear more frequently. Pediatric pneumonia hospitalization rates continued to decline since the introduction of PCV without increasing the frequency of complications. Pneumococcal serotype distribution shifted in parallel. Our findings confirm the efficacy of PCV and support the evidence to include more serotypes in the next generation of PCV.

Cardiovascular outcomes and rates of fractures and falls among patients with brand-name versus generic L-thyroxine use.

To compare cardiovascular outcomes and rates of fractures and falls among patients with persistent brand-name versus generic L-thyroxine use. Retrospective, 1:1 propensity-matched longitudinal study using a national administrative claims database to examine adults (≥18 years) who initiated either brand or generic L-thyroxine between 2008 and 2018, censored at switch or discontinuation of L-thyroxine formulation or disenrollment from the health plan. Main outcome measures included rates of hospitalization for atrial fibrillation, myocardial infarction, congestive heart failure, stroke, spine and hip fractures, and rate of falls in the outpatient or inpatient setting. Hospitalizations for pneumonia were used as a negative control. 195,046 adults initiated treatment with L-thyroxine between 2008 and 2017: 87% generic and 13% brand formulations. They were mostly women (76%), young (94.6% under age 65), white (66%), and 47% had baseline thyroid stimulating hormone levels between 4.5 and 9.9 mIU/L. Among 35,667 propensity-matched patients, there were no significant differences between patients treated with brand versus generic L-thyroxine in atrial fibrillation (HR 0.96, 0.58-1.60), myocardial infarction (HR 0.66, 0.39-1.14), congestive heart failure (HR 1.30, 0.78-2.16), stroke (0.72, 0.49-1.06), spine (HR 0.87, 0.38-1.99) and hip fractures (HR 0.86, 0.26-2.82), or fall outcomes (HR 1.02, 0.14-7.32). Hospitalization rates for pneumonia (used as negative control) did not differ between groups (HR 0.85, 0.61-1.19). There were no interactions between brand versus generic L-thyroxine, these outcomes, and thyroid cancer, age, or L-thyroxine dose subgroups. We found no significant differences in cardiovascular outcomes and rates of falls and fractures for patients who filled brand versus generic L-thyroxine.

SARIMA-modelled greater severity and mortality during the 2010/11 post-pandemic influenza season compared to the 2009 H1N1 pandemic in English hospitals

ObjectiveThe COVID-19 pandemic demonstrates the need for understanding pathways to healthcare demand, morbidity, and mortality of pandemic patients. We estimate H1N1 (1) hospitalization rates, (2) severity rates (length of stay, ventilation, pneumonia, and death) of those hospitalized, (3) mortality rates, and (4) time lags between infections and hospitalizations during the pandemic (June 2009 to March 2010) and post-pandemic influenza season (November 2010 to February 2011) in England. MethodsEstimates of H1N1 infections from a dynamic transmission model are combined with hospitalizations and severity using time series econometric analyses of administrative patient-level hospital data. ResultsHospitalization rates were 34% higher and severity rates of those hospitalized were 20%–90% higher in the post-pandemic period than the pandemic. Adults (45–64-years-old) had the highest ventilation and pneumonia hospitalization rates. Hospitalizations did not lag infection during the pandemic for the young (<24-years-old) but lagged by one or more weeks for all ages in the post-pandemic period. DiscussionThe post-pandemic flu season exhibited heightened H1N1 severity, long after the pandemic was declared over. Policymakers should remain vigilant even after pandemics seem to have subsided. Analysis of administrative hospital data and epidemiological modelling estimates can provide valuable insights to inform responses to COVID-19 and future influenza and other disease pandemics.

SGLT-2 inhibitors and the risk of hospitalization for community-acquired pneumonia: A population-based cohort study.

Sodium-glucose co-transporter 2 inhibitors (SGLT-2i) have been associated with an increased risk of genitourinary tract infections. Through similar biological mechanisms, they may also increase the risk of community-acquired pneumonia. Our objective was to compare the rate of hospitalization for community-acquired pneumonia (HCAP) with SGLT-2i compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) among patients with type 2 diabetes. We used the United Kingdom's Clinical Practice Research Datalink Gold, linked to hospitalization data, to construct a cohort of patients with type 2 diabetes. Using a time-dependent Cox proportional hazards model, we estimated the adjusted hazard ratio (HR) for HCAP with current use of SGLT-2i versus DPP-4i. Among 29 896 patients, 705 HCAPs occurred over a mean follow-up of 1.7 years (SD: 1.2). Incidence rates for SGLT-2i and DPP-4i users were 6.2 (95% confidence interval [CI]: 3.7, 10.2) and 17.8 (95% CI: 15.3, 20.7) per 1000 person-years, respectively. Current use of SGLT-2i was associated with a decreased risk of HCAP compared to current use of DPP-4i (adjusted HR: 0.48, 95% CI: 0.28, 0.82). However, a comparison of SGLT-2i versus glucagon-like peptide-1 receptor agonists (GLP-1 RA) found no difference in risk of HCAP (adjusted HR: 0.94, 95% CI: 0.44, 1.89). SGLT-2i are associated with a decreased rate of HCAP compared to DPP-4i, but not when compared to GLP-1 RA, among patients with type 2 diabetes.

1397. Long term impact of the 13-valent pneumococcal conjugate vaccine use in infant immunization program on all-cause pneumonia hospitalizations in British Columbia, Canada: a time series analysis

BackgroundPneumonia is a leading cause of hospitalization and in-patient mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on all-cause pneumonia hospitalization rates eight years after the vaccine was introduced in British Columbia, Canada.MethodsRoutine administrative databases, such as, hospital discharge abstract databases, registry and demographics were used to build the cohort. Overall and age-specific all-cause pneumonia hospital admissions per month (Jan 2000 to Dec 2018) for those aged < 2 years, 2-5 years, 6-17 years, 18-64 years and ≥ 65 years were obtained using International Classification of Diseases 9 and 10 codes (480-486, J12-J18). Changes in the all-cause pneumonia hospitalization incidence rates before and after the PCV13 vaccine program introduction were evaluated using a negative binomial regression and time-series modelling while adjusting for seasonality, influenza-likeness illnesses, 7-valent pneumococcal conjugate vaccine (PCV7) program and pre-PCV13 vaccine secular trends.ResultsLong term use of the PCV13 vaccine in the infant immunization program was associated with significant declines in all-cause pneumonia hospitalization rates among all children, < 2 years (IRR: 0.63; 95% Confidence Interval (CI): 0.59-0.67), 2-5 years (IRR: 0.82; 95%CI: 0.77-0.87) and 6-17 years (IRR: 0.73; 95%CI: 0.69-0.78). All-cause pneumonia rates did not change significantly in those aged 18-64 years (IRR: 0.98; 95%CI: 0.96-1), whereas a modest increase was observed in those 65 years and over (IRR: 1.05; 95%CI: 1.02-1.07). Consequently, we did not observe significant change in the overall rate (IRR: 1.02; 95%CI: 1-1.02).ConclusionSignificant reduction in all-cause pneumonia hospitalization rates in children demonstrates long term beneficial effect of PCV13 use. A modest increase in all-cause pneumonia hospitalization rates in adults aged 65 years and over indicates a need for further microbial investigation.DisclosuresNirma Khatri Vadlamudi, BA, BS, MPH, Pfizer Inc (Research Grant or Support) Fawziah Marra, BSc (Pharm), PharmD, Pfizer Inc (Research Grant or Support)

Study of the impact of anti-tobacco legislation on public health in the Russian Federation

Abstract Background Smoking increases the risk of developing many diseases, both non-infectious and infectious. On February 23, 2013, the Russian Federation adopted an anti-smoking law, which provided for a two-stage ban on smoking in public places. Since June 1, 2013, smoking has been banned in schools, hospitals, public transport, railway stations, workplaces, and since June 1, 2014 - in trains, hotels, bars, restaurants. Purpose To study the dynamics of monthly hospitalization rates for respiratory diseases and acute otitis media in three regions of the Russian Federation (Chuvash Republic, Samara and Arkhangelsk regions). Methods A retrospective analysis of the monthly hospital incidence of pneumonia of various etiologies (ICD-10 J12-J18), other acute lower respiratory infections (J20-J22), asthma (J45), status asthmaticus (J46) and acute otitis media (H65.0, H65.1, H66.0) from 2012 to 2017. The data were analyzed by the method of interrupted time series. The information was provided by the regional Fund of Medical Insurance. Results Two control points were identified - June 2013 and June 2014. We demonstrated the reduction of hospitalization rates for acute lower respiratory infections and pneumonia immediately after each of the two stages of the anti-smoking policy implementation in all regions studied. In the Arkhangelsk region, the decrease was 19% in 2013 and 22% in 2014, in the Samara region - 20% and 23%, and in the Chuvash Republic - 31% and 39%. The reduction of hospitalization for asthma, status asthmaticus and acute otitis media was observed only in Chuvash Republic: the decrease in the number of hospitalizations for asthma and status asthmaticus was 11% in 2013 and 12% in 2014, and for acute otitis media - 25% and 35%. In other regions the decline was non-significant. Conclusions Anti-tobacco legislation leads to an immediate and significant reduction in the number of hospitalizations for lower respiratory tract infections. Key messages The ban on smoking in public places reduces infections of the lower respiratory tract and acute otitis media. Anti-tobacco legislation has a positive impact on public health.

Exposure to dipeptidyl-peptidase 4 inhibitors and the risk of pneumonia among people with type 2 diabetes: Retrospective cohort study and meta-analysis.

Concerns have been raised that dipeptidyl-peptidase 4 inhibitors (DPP-4i) may increase the risk of pneumonia. We analysed observational data and clinical trials to explore whether use of DPP-4i modifies the risk of pneumonia. We identified patients with diabetes in the Veneto region administrative database and performed propensity score matching between new users of DPP-4 inhibitors and new users of other oral glucose-lowering medications (OGLMs). We compared the rate of hospitalization for pneumonia between matched cohorts using the Cox proportional hazard model. The same analysis was repeated using the database of a local diabetes outpatient clinic. We retrieved similar observational studies from the literature to perform a meta-analysis. Results from trials reporting pneumonia rates among patients randomized to DPP-4 inhibitors versus placebo/active comparators were also meta-analysed. In the regional database, after matching 6495 patients/group, new users of DPP-4 inhibitors had a lower rate of hospitalization for pneumonia than new users of other OGLMs (HR 0.76; 95% CI 0.61-0.95). In the outpatient database, after matching 867 patients/group, new users of DPP-4 inhibitors showed a non-significantly lower rate of hospitalization for pneumonia (HR 0.65; 95% CI 0.41-1.04). The meta-analysis of observational studies yielded an overall non-significant lower risk of hospitalization for pneumonia among DPP-4 inhibitor users (RR 0.81; 95% CI 0.65-1.01). The meta-analysis of randomized controlled trials showed no overall effect of DPP-4 inhibitors on pneumonia risk (RR 1.06; 95% CI 0.93-1.20). The use of DPP-4 inhibitors can be considered as safe with regard to the risk of pneumonia.

Protect Pregnant and Lactating Women with COVID-19 Through Research, Not from Research.

Protect Pregnant and Lactating Women with COVID-19 Through Research, Not from Research.

1613. Rates of Hospitalization for Community-Acquired Pneumonia Among US Adults: A Systematic Review

BackgroundCommunity-acquired pneumonia (CAP) develops in persons outside of a healthcare facility and is associated with significant morbidity and mortality. Estimating the incidence of CAP is challenging because it lacks a standardized case definition and because study designs and selection criteria vary. Reconciling these differences across studies is critical for understanding the true burden of CAP which, in turn, informs prevention strategies, including vaccination.MethodsWe performed a systemic literature review of studies describing the incidence of hospitalized CAP among adults in the United States. Specifically, we examined the impact of the following study characteristics on estimates of incidence: (i) study population, (ii) study type and data source, and (iii) diagnostic criteria for pneumonia.ResultsAfter review of 8361 articles as of January 31, 2019, we identified 26 studies which contained 39 unique CAP estimates. Among adults ≥65 years of age, annual rates of hospitalized CAP ranged from 847 to 3,500 per 100,000 persons with median = 1,830. Rates were lower in studies that excluded patients with healthcare-associated (but community-onset) pneumonia (HCAP; median = 2,003 vs. 1,286; P = .02) or immunocompromising conditions (median = 1,895 vs. 1,409; P = .29). Rates of CAP were also lower in studies that used more restrictive criteria for diagnosing pneumonia (e.g., pneumonia coded in any diagnosis position [median = 2,246] vs. pneumonia coded in the first position only [median = 1,375] in studies of administrative claims; P = 0.03). For adults <65 years of age, annual rates of CAP were lower (range = 89 to 1,024 per 100,000; median = 210).ConclusionCAP causes a significant disease burden among adults, particularly among those ≥65 years of age where the incidence of hospitalization is approximately 2,000 per 100,000 annually. Commonly-applied exclusion criteria (e.g., persons with HCAP or immunocompromising conditions) or restrictive case definitions (e.g., only including pneumonias coded in the primary diagnosis position) have led to systematic underestimation of CAP incidence in many previous studies. Understanding the true burden of adult CAP is critical for highlighting the ongoing need for expanded prevention programs, including vaccination.Disclosures All authors: No reported disclosures.

A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea

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.

Spatial distribution of hospitalization rates of children due to pneumonia in the Unified Health System, in the municipalities of the state of São Paulo.

To identify spatial patterns in the distribution of hospitalization rates of children with pneumonia in the state of São Paulo, Brazil from 2009 to 2013. This was an exploratory ecological study with data obtained from DATASUS of hospitalizations of children with pneumonia in the municipalities in São Paulo from 2009 to 2013/ Data on maternal education and family income were obtained and rates per thousand children were calculated and inserted in a database of municipalities obtained from IBGE. Thematic, kernel and Moran maps were constructed for the hospitalization rates and the Moran indices were calculated. The TerraView program was used for spatial analysis. A total of 43,809 children were hospitalized in the study period, with a minimum of zero and a maximum of 69,072. The mean rate per municipality was 11.51 ± 8.62 (SD). The Moran index was 0.21 (p = 0.01). The thematic map showed clusters in the northern, northwestern, midwestern and southwestern regions of the state; the kernel map showed a higher density of rates in the northwestern and midwestern areas, and the Moran map identified 39 municipalities that deserve the attention of municipal and regional managers. Geoprocessing identifies regions with higher hospitalization rates for pneumonia and also municipalities that deserve a high intervention priority.

Hospitalization Rate and Population-based Incidence of Hospitalization for Community-acquired Pneumonia Among Children in Suzhou, China.

Data on hospitalization burden of community-acquired pneumonia (CAP) in children are very limited in China. This study aimed to estimate the hospitalization rate (HR) and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (International Classification of Diseases, 10th revision) including J09-J18 and J20-J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The HR and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years of age admitted to Soochow University Affiliated Children's Hospital during the study period, 31,302 children were identified as having CCAP and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 [95% confidence interval (CI): 187.1-190.9] and 146.2 (95% CI: 144-148) per 1000 hospitalizations, respectively, and the HIs per 100,000 children annually were CCAP, 3235.8 (95% CI: 3207.3-3264.2) and RCAP, 2503.5 (95% CI: 2478.3-2528.6). For children <5 years of age, the HR for CCAP was 248.4 (95% CI: 245.9-250.9) and RCAP was 194.0 (95% CI: 191.4-196.3) per 1000 hospitalizations; the HI for CCAP was 6956.2 (95% CI: 6892.8-7019.6) and 5431.9 (95% CI: 5375.4-5488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months of age: HR for CCAP was 407.4 (95% CI: 400.9-413.9) per 1000 hospitalizations and HI for CCAP was 11,203.7 (95% CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter and early spring. These data provide valuable information to monitor CAP trends over time in children of Suzhou, China.

Impact of 13-valent pneumococcal conjugate vaccination introduction in children on pneumonia hospitalizations among adults aged 65 or more in Portugal

Background The incidence of pneumonia and pneumonia related hospitalizations still increasing in different European and American Countries. However, in western countries this increase is driven by secondary diagnoses, recurrent pneumonia episodes in elderly and among those with comorbidities. Given the high frequency of Streptococcus pneumoniae among all pneumonia, it is reasonable to expect that a wide use of pneumococcal vaccines would reduce the burden of pneumonia in the elderly due to a direct and indirect effect. In Portugal, pneumococcal vaccines are available since 1996: pneumococcal polysaccharide vaccine (PPSV23) in 1996; heptavalent conjugated pneumococcal vaccines (PCV7) in 2001; PCV10 in April 2009 and PCV13 in January 2010. PPSV23 and PCV13 are widely recommended for risk groups and elderly. PCV7 serotypes reduced from 31% in 1999–2003 to 11% in 2009–2011 in non-invasive pneumococcal pneumonia (PP), but no decreasing trend was observed for PCV13 and PPSV23 serotypes until 2011. Trends in pneumococcal pneumonia after PCV13 introduction are not known in Portugal. Thus, this study aims to assess population level impact of infant PCV13 introduction on burden of pneumonia among adults aged 65 or more in Portugal through comparison of trends in PP hospitalization rates before and after PCV13 introduction. Methods We performed an ecological study using hospital discharge registry data. Pneumococcal Pneumonia was defined as having a principal diagnosis coded as 481 (International Classification for Diseases - 9th version). To assess trends in hospitalization rates before (July 2003–June 2009) and after (July 2010–June 2016) PCV13 introduction interrupted time series analysis was used. Annual average change of pneumonia hospitalization rates was estimated by Poisson regression models adjusted for seasonality and allowing for over-depression. PP hospitalization rates estimated after immunization program introduction were compared with those projected based on pre-vaccination period trend. Bacterial pneumonia caused by pathogens other than S. pneumoniae was used for sensitivity analysis. Results At baseline, the overall PP hospitalization rate was 10.2/104. The rates varied markedly by age group, the highest baseline rates were observed among those aged 85 years or more, 38.6/104 in males and 23.4/104 in females. Statistically significant decline in overall PP hospitalization rate was verified during pre-PCV13 period, the rate decreased on average by 4.6% per year (IRR = 0.954; 95% CI: 0.943 to 0.964). The decreasing trend continued after PCV13 introduction, with more pronounced decline of 12.8% (IRR = 0.872; 95% CI: 0.858 to 0.886) per year. The decrease in PP hospitalizations was significant in all subgroups, the largest decline in both pre-PCV13 (5.8% per year) and PCV13 (14.3% per year) periods was verified for males aged 75–84. Smaller decrease was observed for Bacterial pneumonia after 2010 (IRR = 0.915; 95% CI: 0.913 to 0.937). Conclusions Using population-based nationwide registry data, we found considerable decrease in hospitalizations’ rates for PP in adults aged 65 or more years following infant PCV13 introduction in Portugal. Given the ecological design, we cannot exclude the effect of factors other than vaccination, namely changes in diagnosis and coding practices or the reduction of other pneumonia risk factors as tobacco, since decreasing trend was also observed for bacterial pneumonia after 2010.