Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Statistical Analysis
3. Results
3.1. General Characteristics of Hospitalizations for Pneumonia
3.2. Clinical Characteristics of Patients Hospitalized for Pneumonia
3.3. Trends in Hospitalizations over Time
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Aliberti, S.; Dela Cruz, C.S.; Amati, F.; Sotgiu, G.; Restrepo, M.I. Community-acquired pneumonia. Lancet 2021, 398, 906–919. [Google Scholar] [CrossRef] [PubMed]
- Almirall, J.; Serra-Prat, M.; Bolibar, I.; Balasso, V. Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration 2017, 94, 299–311. [Google Scholar] [CrossRef] [PubMed]
- Fung, H.B.; Monteagudo-Chu, M.O. Community-acquired pneumonia in the elderly. Am. J. Geriatr. Pharmacother. 2010, 8, 47–62. [Google Scholar] [CrossRef] [PubMed]
- Gil-Prieto, R.; Pascual-Garcia, R.; Walter, S.; Alvaro-Meca, A.; Gil-De-Miguel, A. Risk of hospitalization due to pneumococcal disease in adults in Spain. The CORIENNE study. Hum. Vaccines Immunother. 2016, 12, 1900–1905. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ramirez, J.A.; Wiemken, T.L.; Peyrani, P.; Arnold, F.W.; Kelley, R.; Mattingly, W.A.; Nakamatsu, R.; Pena, S.; Guinn, B.E.; Furmanek, S.P.; et al. Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin. Infect. Dis. 2017, 65, 1806–1812. [Google Scholar] [CrossRef] [Green Version]
- Carugati, M.; Aliberti, S.; Reyes, L.F.; Franco Sadud, R.; Irfan, M.; Prat, C.; Soni, N.J.; Faverio, P.; Gori, A.; Blasi, F.; et al. Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study. ERJ Open Res. 2018, 4, 00096-2018. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Carugati, M.; Franzetti, F.; Wiemken, T.; Kelley, R.R.; Peyrani, P.; Blasi, F.; Ramirez, J.; Aliberti, S. De-escalation therapy among bacteraemic patients with community-acquired pneumonia. Clin. Microbiol. Infect. 2015, 21, 936.e11–936.e18. [Google Scholar] [CrossRef] [Green Version]
- ECDC Surveillance Report. Invaasive Pneumococcal Disease. Annual Epidemiological Report. Available online: https://www.ecdc.europa.eu/en/surgical-site-infections/surveillance-and-disease-data/all-annual-epidemiological-reports (accessed on 4 December 2022).
- Fay, M.P.; Tiwari, R.C.; Feuer, E.J.; Zou, Z. Estimating average annual percent change for disease rates without assuming constant change. Biometrics 2006, 62, 847–854. [Google Scholar] [CrossRef]
- Assefa, M. Multi-drug resistant gram-negative bacterial pneumonia: Etiology, risk factors, and drug resistance patterns. Pneumonia 2022, 14, 4. [Google Scholar] [CrossRef]
- Vissink, C.E.; Huijts, S.M.; de Wit, G.A.; Bonten, M.J.; Mangen, M.J. Erratum to: Hospitalization costs for community-acquired pneumonia in Dutch elderly: An observational study. BMC Infect. Dis. 2016, 16, 702. [Google Scholar] [CrossRef]
- McNeil, S.A.; Qizilbash, N.; Ye, J.; Gray, S.; Zanotti, G.; Munson, S.; Dartois, N.; Laferriere, C. A Retrospective Study of the Clinical Burden of Hospitalized All-Cause and Pneumococcal Pneumonia in Canada. Can. Respir. J. 2016, 2016, 3605834. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministero Della Saulte. Available online: https://www.salute.gov.it/portale/documentazione/p6_2_8_3_1.jsp?lingua=italiano&id=20 (accessed on 24 August 2022).
- Amodio, E.; Costantino, C.; Boccalini, S.; Tramuto, F.; Maida, C.M.; Vitale, F. Estimating the burden of hospitalization for pneumococcal pneumonia in a general population aged 50 years or older and implications for vaccination strategies. Hum Vaccines Immunother. 2014, 10, 1337–1342. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dirmesropian, S.; Liu, B.; Wood, J.G.; MacIntyre, C.R.; McIntyre, P.; Karki, S.; Jayasinghe, S.; Newall, A.T. Pneumonia hospitalisation and case-fatality rates in older Australians with and without risk factors for pneumococcal disease: Implications for vaccine policy. Epidemiol. Infect. 2019, 147, e118. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Konomura, K.; Nagai, H.; Akazawa, M. Economic burden of community-acquired pneumonia among elderly patients: A Japanese perspective. Pneumonia 2017, 9, 19. [Google Scholar] [CrossRef] [Green Version]
- Hillock, N.T.; Merlin, T.L.; Turnidge, J.; Karnon, J. Modelling the Future Clinical and Economic Burden of Antimicrobial Resistance: The Feasibility and Value of Models to Inform Policy. Appl. Health Econ. Health Policy 2022, 20, 479–486. [Google Scholar] [CrossRef]
- Tessmer, A.; Welte, T.; Schmidt-Ott, R.; Eberle, S.; Barten, G.; Suttorp, N.; Schaberg, T.; Group, C.S. Influenza vaccination is associated with reduced severity of community-acquired pneumonia. Eur. Respir. J. 2011, 38, 147–153. [Google Scholar] [CrossRef] [Green Version]
- Tang, H.J.; Lai, C.C.; Chao, C.M. Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic. Antibiotics 2022, 11, 315. [Google Scholar] [CrossRef]
- Murillo-Zamora, E.; Trujillo, X.; Huerta, M.; Rios-Silva, M.; Guzman-Esquivel, J.; Benites-Godinez, V.; Ochoa-Castro, M.R.; Guzman-Solorzano, J.A.; Mendoza-Cano, O. COVID-19 vaccines provide better protection against related pneumonia than previous symptomatic infection. Int. J. Infect. Dis. 2022, 120, 142–145. [Google Scholar] [CrossRef]
- Wada, N.; Li, Y.; Hino, T.; Gagne, S.; Valtchinov, V.I.; Gay, E.; Nishino, M.; Madore, B.; Guttmann, C.R.G.; Bond, S.; et al. COVID-19 Vaccination reduced pneumonia severity. Eur. J. Radiol. Open 2022, 9, 100456. [Google Scholar] [CrossRef]
- Kim, G.L.; Seon, S.H.; Rhee, D.K. Pneumonia and Streptococcus pneumoniae vaccine. Arch. Pharmacal Res. 2017, 40, 885–893. [Google Scholar] [CrossRef]
- Suaya, J.A.; Jiang, Q.; Scott, D.A.; Gruber, W.C.; Webber, C.; Schmoele-Thoma, B.; Hall-Murray, C.K.; Jodar, L.; Isturiz, R.E. Post hoc analysis of the efficacy of the 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia in at-risk older adults. Vaccine 2018, 36, 1477–1483. [Google Scholar] [CrossRef] [PubMed]
- Bonten, M.J.; Huijts, S.M.; Bolkenbaas, M.; Webber, C.; Patterson, S.; Gault, S.; van Werkhoven, C.H.; van Deursen, A.M.; Sanders, E.A.; Verheij, T.J.; et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N. Engl. J. Med. 2015, 372, 1114–1125. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McLaughlin, J.M.; Jiang, Q.; Isturiz, R.E.; Sings, H.L.; Swerdlow, D.L.; Gessner, B.D.; Carrico, R.M.; Peyrani, P.; Wiemken, T.L.; Mattingly, W.A.; et al. Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design. Clin. Infect. Dis. 2018, 67, 1498–1506. [Google Scholar] [CrossRef] [PubMed]
- Chandler, T.; Furmanek, S.; Carrico, R.; Balcom, D.; Arnold, F.; Ramirez, J. 23-Valent Pneumococcal Polysaccharide Vaccination Does Not Prevent Community-Acquired Pneumonia Hospitalizations Due to Vaccine-Type Streptococcus pneumoniae. Microorganisms 2022, 10, 560. [Google Scholar] [CrossRef]
- Torres, A.; Menendez, R.; Espana, P.P.; Fernandez-Villar, J.A.; Marimon, J.M.; Cilloniz, C.; Mendez, R.; Egurrola, M.; Botana-Rial, M.; Ercibengoa, M.; et al. The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011-2018. Clin. Infect. Dis. 2021, 73, 1075–1085. [Google Scholar] [CrossRef]
- Ladhani, S.N.; Collins, S.; Djennad, A.; Sheppard, C.L.; Borrow, R.; Fry, N.K.; Andrews, N.J.; Miller, E.; Ramsay, M.E. Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000–2017: A prospective national observational cohort study. Lancet Infect. Dis. 2018, 18, 441–451. [Google Scholar] [CrossRef] [Green Version]
- Huang, L.; Wasserman, M.; Grant, L.; Farkouh, R.; Snow, V.; Arguedas, A.; Chilson, E.; Sato, R.; Perdrizet, J. Burden of pneumococcal disease due to serotypes covered by the 13-valent and new higher-valent pneumococcal conjugate vaccines in the United States. Vaccine 2022, 40, 4700–4708. [Google Scholar] [CrossRef]
Total Number of Pneumonia Hospitalizations | Incidence Rate Per 100,000 | % | ||
---|---|---|---|---|
Total | 2,481,213 | 411.2 | 100% | |
Gender | ||||
Male | 1,372,040 | 468.5 | 55.3% | |
Female | 1,109,103 | 357 | 44.7% | |
Age (years) | ||||
<18 | 265,354 | 264.9 | 10.7% | |
18–45 | 150,804 | 71.2 | 6.1% | |
46–65 | 330,032 | 196.1 | 13.3% | |
66–75 | 411,426 | 651.1 | 16.6% | |
76–85 | 747,507 | 1688.50 | 30.1% | |
>85 | 576,095 | 3681.60 | 23.2% | |
Year | ||||
2010 | 218,152 | 365.4 | 8.8% | |
2011 | 223,389 | 374.1 | 9.0% | |
2012 | 220,349 | 369.0 | 8.9% | |
2013 | 229,607 | 384.6 | 9.3% | |
2014 | 241,632 | 404.7 | 9.7% | |
2015 | 255,607 | 428.1 | 10.3% | |
2016 | 246,460 | 412.8 | 9.9% | |
2017 | 267,217 | 447.5 | 10.8% | |
2018 | 282,850 | 473.7 | 11.4% | |
2019 | 295,950 | 495.7 | 11.9% |
ICD9-CM Diagnosis Code | ICD9-CM Diagnosis Description | Diagnostic Groups | Total Specified Cases 2010–2019 | % Specified Cases out of Total Specified Cases 2010–2019 |
---|---|---|---|---|
481 | Pneumococcal pneumonia (Streptococcus pneumoniae) | Specified Pneumonia bacterial | 53,879 | 20.44% |
482.89 | Pneumonia from other specified bacteria | Specified Pneumonia bacterial | 44,947 | 17.05% |
483.0 | Mycoplasma Pneumoniae pneumonia | Specified Pneumonia bacterial | 33,532 | 12.72% |
482.1 | Pseudomonas pneumonia | Specified Pneumonia bacterial | 32,106 | 12.18% |
482.41 | Staphylococcus aureus pneumonia | Specified Pneumonia bacterial | 18,239 | 6.92% |
482.0 | Klebsiella pneumoniae pneumonia | Specified Pneumonia bacterial | 15,824 | 6.00% |
487.0 | Influenza with pneumonia | Specified Pneumonia viral | 14,779 | 5.61% |
482.82 | Escherichia coli pneumonia [E. coli] | Specified Pneumonia bacterial | 7226 | 2.74% |
484.6 | Pneumonia in aspergillosis | Specified Pneumonia fungi | 6525 | 2.47% |
483.1 | Chlamydia Pneumonia | Specified Pneumonia bacterial | 6061 | 2.30% |
482.2 | Haemophilus influenzae pneumonia (H. influenzae) | Specified Pneumonia bacterial | 5777 | 2.19% |
482.30 | Streptococcus pneumonia, unspecified | Specified Pneumonia bacterial | 5301 | 2.01% |
480.1 | Respiratory syncytial virus pneumonia | Specified Pneumonia viral | 4914 | 1.86% |
482.40 | Staph pneumonia, unspecified | Specified Pneumonia bacterial | 3094 | 1.17% |
482.39 | Pneumonia from other Streptococci | Specified Pneumonia bacterial | 2597 | 0.99% |
484.1 | Cytomegalovirus pneumonia | Specified Pneumonia viral | 2548 | 0.97% |
480.0 | Adenovirus Pneumonia | Specified Pneumonia viral | 2359 | 0.89% |
480.2 | Parainfluenza virus pneumonia | Specified Pneumonia viral | 2154 | 0.82% |
482.31 | Streptococcus pneumonia, group A | Specified Pneumonia bacterial | 965 | 0.37% |
482.32 | Streptococcus pneumonia, group B | Specified Pneumonia bacterial | 390 | 0.15% |
484.3 | Pneumonia in whooping cough | Specified Pneumonia bacterial | 225 | 0.09% |
480.3 | SARS pneumonia—Associated coronavirus | Specified Pneumonia viral | 163 | 0.06% |
484.5 | Pneumonia in anthrax | Specified Pneumonia bacterial | 20 | 0.01% |
482.4 | Staph pneumonia | Specified Pneumonia bacterial | 14 | 0.01% |
Total Number of Pneumonia Hospitalizations | Incidence Rate Per 100,000 | % * | ||
---|---|---|---|---|
ICD-9 Pneumonia Code Position | ||||
Principal position | 1,374,227 | 227.7 | 55.4% | |
Second position | 1,106,991 | 183.4 | 44.6% | |
ICD-19 Pneumonia Code | ||||
Unspecified pneumonia | 783,574 | 129.8 | 31.6% | |
Unspecified pneumonia viral | 25,290 | 4.2 | 1.0% | |
Unspecified pneumonia bacterial | 514,174 | 85.2 | 20.7% | |
Unspecified bronchopneumonia | 889,320 | 147.4 | 35.8% | |
Specified pneumonia viral | 24,265 | 4.00 | 1.0% | |
Specified pneumonia bacterial | 224,320 | 37.20 | 9.0% | |
Specified pneumonia fungal | 5719 | 0.90 | 0.2% | |
Other | 10,110 | 1.70 | 0.4% | |
Coinfection | 4441 | 0.70 | 0.2% | |
Comorbidities | ||||
Chronic respiratory disease | 438,730 | 72.7 | 17.7% | |
Chronic cardiovascular disease | 173,437 | 28.7 | 7.0% | |
Chronic kidney disease | 170,136 | 28.2 | 6.9% | |
Cancer | 274,394 | 45.5 | 11.1% | |
Diabetes mellitus | 271,262 | 45 | 10.9% | |
At least one comorbidity | 677,903 | 112.3 | 27.3% | |
At least two comorbidities | 230,401 | 38.2 | 9.3% | |
Three or more comorbidities | 52,023 | 8.6 | 2.1% | |
Discharge disposition | ||||
Routine discharge | 1,775,817 | 294.3 | 71.6% | |
Transfer | 191,474 | 31.7 | 7.7% | |
In-hospital death | 322,474 | 53.4 | 13.0% | |
Other | 191,453 | 31.7 | 7.7% |
Variable | Annual Percent Change | p-Value | |
---|---|---|---|
Raw hospitalization rates | +3.47 | <0.001 | |
Gender | Male | +3.08 | <0.001 |
Female | +3.93 | <0.001 | |
Age (years) | <18 | −4.25 | 0.004 |
18–45 | −1.02 | 0.304 | |
46–65 | +3.67 | <0.001 | |
66–75 | +3.53 | <0.001 | |
76–85 | +4.32 | 0.003 | |
>85 | +7.49 | 0.003 | |
Diagnosis (Position) | Pneumonia in first diagnosis | +1.35 | 0.011 |
Pneumonia in secondary diagnosis | +6.18 | 0.003 | |
Diagnosis | Unspecified pneumonia | +5.48 | 0.002 |
Unspecified pneumonia viral | +4.60 | 0.009 | |
Unspecified pneumonia bacterial | +5.86 | <0.001 | |
Unspecified bronchopneumonia | +0.10 | 0.761 | |
Specified pneumonia viral | +11.62 | 0.003 | |
Specified pneumonia bacterial | +3.33 | 0.003 | |
Specified pneumonia fungi | +6.38 | 0.001 | |
Other | +5.99 | <0.001 | |
Coinfection | +16.11 | 0.001 | |
Comorbidities | Chronic respiratory diseases | +3.60 | <0.001 |
Chronic cardiovascular diseases | +2.85 | <0.001 | |
Chronic kidney diseases | +5.21 | <0.001 | |
Cancer | +3.02 | <0.001 | |
Diabetes | +1.86 | <0.001 | |
Comorbidities (number) | At least one comorbidity | +3.76 | <0.001 |
At least two comorbidities | +2.90 | <0.001 | |
Three or more comorbidities | +2.19 | 0.002 | |
Discharge disposition | Routine discharge | +2.13 | 0.001 |
Transfer | +9.08 | <0.001 | |
In-hospital death | +4.56 | <0.001 | |
Other | +9.00 | <0.001 | |
Hospitalization costs (euro) | +3.95 | <0.001 | |
In-hospital death | +4.60 | <0.001 | |
Length of stay (days) | +0.31 | 0.038 | |
DRG weight * | +0.57 | 0.003 |
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Amodio, E.; Vitale, F.; d’Angela, D.; Carrieri, C.; Polistena, B.; Spandonaro, F.; Pagliaro, A.; Montuori, E.A. Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action. Vaccines 2023, 11, 187. https://doi.org/10.3390/vaccines11010187
Amodio E, Vitale F, d’Angela D, Carrieri C, Polistena B, Spandonaro F, Pagliaro A, Montuori EA. Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action. Vaccines. 2023; 11(1):187. https://doi.org/10.3390/vaccines11010187
Chicago/Turabian StyleAmodio, Emanuele, Francesco Vitale, Daniela d’Angela, Ciro Carrieri, Barbara Polistena, Federico Spandonaro, Alessandra Pagliaro, and Eva Agostina Montuori. 2023. "Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action" Vaccines 11, no. 1: 187. https://doi.org/10.3390/vaccines11010187
APA StyleAmodio, E., Vitale, F., d’Angela, D., Carrieri, C., Polistena, B., Spandonaro, F., Pagliaro, A., & Montuori, E. A. (2023). Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action. Vaccines, 11(1), 187. https://doi.org/10.3390/vaccines11010187