Pneumonia Hospitalization Rates on The Rise for Older Adults
Hospitalization rates for pneumonia have increased substantially for U.S. adults 65 to 84 years of age, according to a study in the December 7 issue of JAMA.
Pneumonia is among the top 10 causes of death in the United States and is a significant cause of outpatient visits and hospitalizations, according to background information in the article. Factors that increase the risk for pneumonia include the presence of underlying medical conditions, advanced age, functional disability, and residency in long-term care facilities.
Alicia M. Fry, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine if an increase in chronic underlying conditions might be contributing to greater hospitalization rates for pneumonia. The researchers used data from the National Hospital Discharge Survey (NHDS) to study trends according to age groups in hospitalization rates for pneumonia during a 15-year period (1988-2002) among U.S. residents aged 65 years or older. The characteristics, outcomes, and comorbid (co-existing illness) disease diagnoses of patients with a hospital discharge diagnosis of pneumonia were compared with those of patients with a hospital discharge diagnosis for other causes during the study period.
The researchers found that hospitalization rates for pneumonia increased by 20 percent from 1988-1990 to 2000-2002 for patients aged 65 to 74 years and for patients aged 75 to 84 years. Rates of hospitalization for pneumonia were 2-fold higher for patients aged 85 years or older (51 per 1,000 population for first-listed discharge code of pneumonia) than among patients aged 75 to 84 years but did not significantly increase from 1988-1990 to 2000-2002. The proportion of patients aged 65 years or older diagnosed with pneumonia and a chronic cardiac disease, chronic pulmonary disease, or diabetes mellitus increased from 66 percent in 1988-1990 to 77 percent in 2000-2002. During 2000-2002, approximately 1 in 83 patients aged 65 to 74 years and 1 in 38 patients aged 74 to 84 years were hospitalized each year with a first-listed diagnosis of pneumonia.
"The increasing proportion of patients with underlying comorbid conditions among those hospitalized for pneumonia supports our primary hypothesis that an increase in the prevalence of underlying conditions that predispose individuals to pneumonia might partially account for the increase in rates of pneumonia hospitalization among patients aged 65 to 84 years. Our findings suggest that efforts to prevent pneumonia among older adults should focus on those at the extremes of age and those with underlying medical conditions," the authors write.
"... because the number of individuals at highest risk for pneumonia, those aged 85 years or older, will continue to increase in the United States and behavioral changes may be difficult to sustain, additional strategies, such as more effective vaccines for older individuals and new vaccines for common pathogens without a currently licensed vaccine ... will likely be necessary," they write. (JAMA. 2005;294:2712-2719)