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Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study

  • S. A. SKULL (a1) (a2) (a3), R. M. ANDREWS (a2), G. B. BYRNES (a4), D. A. CAMPBELL (a5) (a6), H. A. KELLY (a6) (a7), G. V. BROWN (a8) and T. M. NOLAN (a3) (a6)...

Summary

This study describes the epidemiology of community-acquired pneumonia (CAP) in elderly Australians for the first time. Using a case-cohort design, cases with CAP were in-patients aged ⩾65 years with ICD-10-AM codes J10-J18 admitted over 2 years to two tertiary hospitals. The cohort sample was randomly selected from all hospital discharges, frequency-matched to cases by month. Logistic regression was used to estimate risk ratios for factors predicting CAP or associated mortality. A total of 4772 in-patients were studied. There were 1952 cases with CAP that represented 4% of all elderly admissions: mean length of stay was 9·0 days and 30-day mortality was 18%. Excluding chest radiograph, 520/1864 (28%) cases had no investigations performed. The strongest predictors of CAP were previous pneumonia, history of other respiratory disease, and aspiration. Intensive-care-unit admission, renal disease and increasing age were the strongest predictors of mortality, while influenza vaccination conferred protection. Hospitalization with CAP in the elderly is common, frequently fatal and a considerable burden to the Australian community. Investigation is ad hoc and management empirical. Influenza vaccination is associated with reduced mortality. Patient characteristics can predict risk of CAP and subsequent mortality.

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Copyright

Corresponding author

*Author for correspondence: Assoc. Professor S. A. Skull, Menzies School of Health Research, PO Box 41096, Casuarina, Northern Territory, Australia, 0810. (Email: saskull@unimelb.edu.au)

References

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1.Niederman, MS, Ahmed, QAA.Community-acquired pneumonia in elderly patients. Clinics in Geriatric Medicine 2003; 19: 101120.
2.Loeb, M.Pneumonia in older persons. Clinical Infectious Diseases 2003; 37: 13351339.
3.Vila-Córcoles, A, et al. Protective effect of pneumococcal vaccine against death by pneumonia in elderly subjects. European Respiratory Journal 2005; 26: 10861091.
4.Jokinen, C, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. American Journal of Epidemiology 2003; 137: 977988.
5.Wilson, PA, Ferguson, J. Severe community-acquired pneumonia: an Australian perspective. Internal Medicine Journal 2005; 35: 699705.
6.Padiglione, AA, et al. Characteristics of patients with community-acquired pneumococcal pneumonia. Medical Journal of Australia 1999; 170: 165167.
7.Thompson, JE.Community acquired pneumonia in north eastern Australia – a hospital based study of aboriginal and non-aboriginal patients. Australian & New Zealand Journal of Medicine 1997; 27: 5961.
8.Lim, I, et al. A prospective hospital study of the aetiology of community-acquired pneumonia. Medical Journal of Australia 1989; 151: 8791.
9.Wacholder, S.Practical considerations in choosing between the case-cohort and nested case-control designs. Epidemiology 1991; 2: 155158.
10.Department of Human Services Victoria. Victorian Inpatient Minimum Dataset 1996–1999. Melbourne, 2004.
11.Smith, PR.What diagnostic tests are needed for community-acquired pneumonia? Medical Clinics of North America 2001; 85: 13811396.
12.Metlay, JP, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Archives of Internal Medicine 1997; 157: 14531459.
13.Neill, AM, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996; 51: 10101016.
14.Intercooled Stata 9.1 for Windows. Version 9.1 [program]. College Station, TX: StataCorp LP, 2005.
15.Marston, BJ, et al. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Archives of Internal Medicine 1997; 157: 17091718.
16.Tsirgiotis, E, Ruffin, R. Community acquired pneumonia. A perspective for general practice. Australian Family Physician 2000; 29: 639645.
17.Kaplan, V, et al. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. American Journal of Respiratory and Critical Care Medicine 2002; 165: 766772.
18.Riquelme, R, et al. Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. American Journal of Respiratory and Critical Care Medicine 1996; 154: 14501455.
19.Conte, HA, et al. A prognostic rule for elderly patients admitted with community-acquired pneumonia. American Journal of Medicine 1999; 106: 2028.
20.Koivula, I, Sten, M, Makela, PH. Risk factors for pneumonia in the elderly. American Journal of Medicine 1994; 96: 313320.
21.Mortensen, EM, et al. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Archives of Internal Medicine 2002; 162: 10591064.
22.Kaplan, V, et al. Pneumonia: still the old man's friend? [see comment]. Archives of Internal Medicine 2003; 163: 317323.
23.Rivetti, D, et al. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004876.
24.Skull, SA, et al. Prevention of community-acquired pneumonia among a cohort of hospitalized elderly: benefit due to influenza and pneumococcal vaccination not demonstrated. Vaccine 2007; 25: 46314640.
25.Loeb, M. Epidemiology of community- and nursing home-acquired pneumonia in older adults. Expert Review of Antiinfective Therapy 2005; 3: 263270.
26.Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic, 11th edn.North Melbourne: Therapeutic Guidelines Limited, 2000.
27.Skull, SA, et al. ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged ⩾65 years. Epidemiology and Infection 2008; 136: 232240.
28.Andrews, RM. Assessment of vaccine coverage following the introduction of a publicly funded pneumococcal vaccine program for the elderly in Victoria, Australia. Vaccine 2005; 23: 27562761.

Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study

  • S. A. SKULL (a1) (a2) (a3), R. M. ANDREWS (a2), G. B. BYRNES (a4), D. A. CAMPBELL (a5) (a6), H. A. KELLY (a6) (a7), G. V. BROWN (a8) and T. M. NOLAN (a3) (a6)...

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