Health & Medical Public Health

Burden of Community-Acquired Pneumonia in Elders: The Spanish EVAN-65 Study

´╗┐Burden of Community-Acquired Pneumonia in Elders: The Spanish EVAN-65 Study
Background: Community-acquired pneumonia (CAP) is generally considered a major cause of morbidity and mortality in the elderly. However, population-based data are very limited and its overall burden is unclear. This study assessed incidence and mortality from CAP among Spanish community-dwelling elderly.
Methods: Prospective cohort study that included 11,240 individuals aged 65 years or older, who were followed from January 2002 until April 2005. 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.
Results: Incidence rate of overall CAP was 14 cases per 1,000 person-year (95% confidence interval: 12.7 to 15.3). Incidence increased dramatically by age (9.9 in people 65-74 years vs 29.4 in people 85 years or older), and it was almost double in men than in women (19.3 vs 10.1). Hospitalisation rate was 75.1%, with a mean length-stay of 10.4 days. Overall 30-days case-fatality rate was 13% (15% in hospitalised and 2% in outpatient cases).
Conclusion: CAP remains as a major health problem in older adults. Incidence rates in this study are comparable with rates described in Northern Europe and America, but they largely doubled prior rates reported in other Southern European regions.

Community-acquired pneumonia (CAP) is a relatively frequent infectious illness which causes important morbidity worldwide The reported incidence rates of radiographically confirmed CAP in different populations have varied between 1.3 and 11.6 cases per 1,000 inhabitant-year, with the highest rates in older adults.

Nowadays, CAP cases in older adults increase as a consequence of an overall increase in the elderly population (persons aged 65 years or older) In developed countries, almost one half of the total hospitalisations for pneumonia occur in patients over 65 years and pneumonia is a leading cause of death among this age group. However, despite the recognised importance of CAP in the elderly, information on the epidemiology of CAP in this age group is limited and the true burden of the disease is not well known, considering that incidence and mortality rates in elderly populations have largely varied in different studies.

Incidence rates varying between 2-40 cases per 1,000 elderly person-year and case-fatality rates between 7-35% have been reported for elderly patients in Europe and North America during the last two decades. However, most prior studies were conducted among general adult populations and included only a limited number of elderly individuals, many studies focused on hospitalised patients, and few studies focused on the possible contribution of outpatient cases To our knowledge, only two population-based studies specifically focused on older adults, including hospitalised and outpatient cases of CAP, have been published.

In this study, we have assessed the overall burden of CAP (hospitalised and outpatient cases) in a population-based cohort of Spanish community-dwelling elderly individuals followed between 2002 and 2005. In prior reports we assessed the effectiveness of the pneumococcal vaccine in preventing pneumonia and death in this same cohort.

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