Epidemiology of community-acquired pneumonia in older adults: A population-based study

• Published in: Respiratory medicine Vol. 103; no. 2; pp. 309 - 316
• Main Authors: Vila-Corcoles, Angel, Ochoa-Gondar, Olga, Rodriguez-Blanco, Teresa, Raga-Luria, Xavier, Gomez-Bertomeu, Frederic
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.02.2009; Elsevier; Elsevier Limited
• Subjects: Aetiology; Aged; Aged, 80 and over; Biological and medical sciences; Clinical characteristics; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - prevention & control; Community-acquired pneumonia; Drug therapy; Elderly; Epidemiology; Fatalities; Female; Hospitalization - statistics & numerical data; Humans; Incidence; Male; Medical sciences; Older people; Pneumology; Pneumonia; Pneumonia - drug therapy; Pneumonia - epidemiology; Pneumonia - prevention & control; Primary Health Care - statistics & numerical data; Pulmonary/Respiratory; Respiratory system : syndromes and miscellaneous diseases; Risk factors; Spain - epidemiology; Studies; Spain; Clinical characteristics; Community-acquired pneumonia; Elderly; Aetiology; Risk factors; Incidence; Human; Lung disease; Pneumonia; Respiratory disease; Epidemiology; Symptomatology; Community acquired infection; Etiology; Risk factor; Adult; Population; Pneumology
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2008.08.006

This study assessed incidence, aetiology, clinical outcomes and risk factors for community-acquired pneumonia (CAP) in older adults. This was a population-based cohort study that included 11,241 community-dwelling individuals aged 65 years or more, who were followed between 2002 and 2005 in the region of Tarragona, Spain. Primary endpoints were all-cause CAP (hospitalised and outpatient) and 30-day mortality after the diagnosis. All cases were radiographically proved and validated by checking clinical records. Incidence rate of overall CAP was 14 cases per 1000 person-years (10.5 and 3.5 for hospitalised and outpatient cases, respectively). Incidence was almost three-fold higher among immunocompromised patients (30.9 per 1000) than among immunocompetent subjects (11.6 per 1000). Maximum incidences were observed among patients with chronic lung disease and long-term corticosteroid therapy (46.5 and 40.1 cases per 1000 person-years, respectively). Overall 30-day case-fatality rate was 12.7% (2% in cases managed as outpatient and 15% in hospitalised patients). Among 358 patients with an aetiological work-up, a total of 142 pathogens were found (single pathogen in 121 cases and mixed pathogens in 10 cases). Streptococcus pneumoniae was the most common pathogen (49%), followed by Pseudomonas aeruginosa (15%), Chlamydia pneumoniae (9%) and Haemophilus influenzae (6%). In multivariable analysis, the variables most strongly associated with increasing risk of CAP were history of hospitalisation for CAP in the previous 2 years and presence of any chronic lung disease. CAP remains a major cause of morbidity and mortality in older adults. Incidence rates in this study largely doubled prior rates reported in Southern European regions.