1. Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998–2014
- Author
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Katie Jeffery, Nicola Jones, Tim E. A. Peto, A. Sarah Walker, Derrick W. Crook, John M. Wrightson, Nicola J Fawcett, T Phuong Quan, John Finney, Brian Shine, Lorraine Clarke, and David H. Wyllie
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Population ageing ,Pediatrics ,medicine.medical_specialty ,Respiratory Infection ,medicine.disease_cause ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Community-acquired pneumonia ,Streptococcus pneumoniae ,medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,Aged ,biology ,business.industry ,Incidence ,Incidence (epidemiology) ,C-reactive protein ,Pneumonia ,Middle Aged ,medicine.disease ,3. Good health ,Community-Acquired Infections ,Hospitalization ,England ,030228 respiratory system ,biology.protein ,symbols ,Female ,Diagnosis code ,business - Abstract
Background Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity in many countries but few recent large-scale studies have examined trends in its incidence. Methods Incidence of CAP leading to hospitalisation in one UK region (Oxfordshire) was calculated over calendar time using routinely collected diagnostic codes, and modelled using piecewise-linear Poisson regression. Further models considered other related diagnoses, typical administrative outcomes, and blood and microbiology test results at admission to determine whether CAP trends could be explained by changes in case-mix, coding practices or admission procedures. Results CAP increased by 4.2%/year (95% CI 3.6 to 4.8) from 1998 to 2008, and subsequently much faster at 8.8%/year (95% CI 7.8 to 9.7) from 2009 to 2014. Pneumonia-related conditions also increased significantly over this period. Length of stay and 30-day mortality decreased slightly in later years, but the proportions with abnormal neutrophils, urea and C reactive protein (CRP) did not change (p>0.2). The proportion with severely abnormal CRP (>100 mg/L) decreased slightly in later years. Trends were similar in all age groups. Streptococcus pneumoniae was the most common causative organism found; however other organisms, particularly Enterobacteriaceae , increased in incidence over the study period (p Conclusions Hospitalisations for CAP have been increasing rapidly in Oxfordshire, particularly since 2008. There is little evidence that this is due only to changes in pneumonia coding, an ageing population or patients with substantially less severe disease being admitted more frequently. Healthcare planning to address potential further increases in admissions and consequent antibiotic prescribing should be a priority.
- Published
- 2016