Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study

Izquierdo, Conchita; Oviedo, Margarita Herrero; Ruíz, Laura; Sintes, Xavier; Vera, Isabel; Nebot, Manel; Bayas, JM; Carratalà, Jordi; Varona, Wenceslao; Sousa, Dolores; Celorrio, Jose-Miguel; Salleras, L.; Domı́nguez, Àngela

doi:10.1186/1471-2458-10-421

Cited by 17 publications

(16 citation statements)

References 25 publications

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“…15 However it is inconsistent with the other research literature stated by Izquierdo C which indicated that CAP has no association with poverty and income status. 16 In the present study it was found that hypertensive patient were 131(16.4%) and patients with diabetes were 105(13.1%) coexisted with CAP. In our study we analyzed that hypertension and diabetes was predominantly found in community acquired pneumonia patients with the highest ratio as compared to other comorbid diseases.…”

Section: Discussionsupporting

confidence: 46%

Pneumonia Severity Index (Psi); Assessment of Patient’s Profiles and the Length of Stay in Hospitalized Community Acquired Pneumonia Patient in Different Hospital Setting in Karachi

Khan¹,

Naqvi

Alam

et al. 2016

TPMJ

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… Morbidity and mortality due to community acquired pneumonia has been increased in our country. Children and old age patients are mostly effected due to community acquired pneumonia Study design: Cross sectional study. Setting: Patients hospitalized for Community acquired pneumonia in four different hospitals located at different areas were studied. Period: Three years period from August 2011 to August 2014. Objectives: To assess demographic profile, pneumonia severity index and length of stay of community acquired pneumonia patients hospitalized at different hospitals in Karachi. Method: 800 patients both male and females patients were included in this study. Results: It was found that 480 (60%) were males and 320 (40%) were females, males were significantly more frequent (c 2 =0.48, p˂0.05) than the females patients. There was a significance difference in numbers of different age group patients. According to the age distribution, there were 222(27.75%) from 1-5 years, which was the highest among the patients and there were 44(5.5%) from 81-90 years of age group patients, which was least among the different age group patients. According to the comorbidity most of the patients were found without comorbidity there were 456(57%) patients possess no comorbidity. Patients with comorbidity were 344(43%), and comorbidity was found in patients with hypertension were 131(16.4%) and patients with diabetes were 105(13.1%) these were the two most commonly comorbidity disease found. According to the socioeconomic status (SES) status there were 482(60.25%) patients from lower SES class, 270(33.8%) patient from middle SES class and 54(6.8%) patients from high Socioeconomic class. patient with low SES were much higher at hospital C and hospital D.(c 2 =127.88,p˂0.05). CAP is more frequent in married patients, married patients status were much higher at hospital C and hospital D (c 2 =60.31, p˂0.05). According to the PSI segregation there were 424(53%) patients from PSI class I, 168(21%) were from PSI class II, 128(16%) patients were from PSI class III, 44(5.5%) were from class IV and 36(4.5%) were from PSI class V. Mean length of stay (LOS) was greater at hospital C and D as compare to other two hospitals. Conclusion: CAP is frequent among males, low socioeconomic , hypertensive individuals and patients from 1-5 years of age. The shortest mean length found was 3.6days at hospital A and the longest mean length of stay found was 7.6 days at hospital D.

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Section: Discussionsupporting

confidence: 46%

Pneumonia Severity Index (Psi); Assessment of Patient’s Profiles and the Length of Stay in Hospitalized Community Acquired Pneumonia Patient in Different Hospital Setting in Karachi

Khan¹,

Naqvi

Alam

et al. 2016

TPMJ

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“…14 Overall observed 30-day mortality in patients aged 65 y was 7.6%, higher than in a previous Spanish study 17 but lower than in other studies in which 30-day mortality due to CAP in the elderly ranged from 12.5% to 15.5%. 10,18 Our results show that 30-day mortality in patients aged >84 y was 2.6 times greater, similar to the 3-fold higher rate found in patients aged 85 y compared with those aged 65-74 y found by Ochoa-Gondar et al 10 This supports a specific role of age as a predictor of 30-day mortality in patients with CAP, as reflected by the PSI.…”

Section: Discussioncontrasting

confidence: 43%

Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons

Torner

Izquierdo

Soldevila

et al. 2016

Human Vaccines & Immunotherapeutics

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Community-acquired pneumonia (CAP) refers to pneumonia unrelated to hospitals or extended-care facilities. The aim of this study was to determine factors associated with 30-day mortality in patients with CAP aged 65 y admitted to 20 hospitals in 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Logistic regression was used to identify factors associated with 30-day mortality. The adjusted model included variables selected by backward elimination with a cut off of < 0.02. A total of 1928 CAP cases were recorded; 60.7% were male, 46.67% were aged 75-84 years, and 30-day mortality was 7.6% (n D 146). Pneumococcal vaccination had a significant protective effect (OR 0.68, 95% CI, 0.48-0.96; p D 0.03) and influenza vaccination in any 3 preceding seasons slight protective effect against CAP (OR 0.72, 95% CI, 0.51-1.02;p D 0.06). Factors significantly associated with 30-day mortality were having a degree of dependence (aOR 3.67, 95% CI, 2.34-5.75; p < 0,001); age 85 y (OR 3.01, 95% CI, 1.71-5.30; p < 0.001), liver impairment (aOR 2.41, 95% CI, 1.10-5.31; p D 0.03); solid organ neoplasm (aOR 2.24, 95% CI, 1.46-3.45; p < 0.001), impaired cognitive function (aOR 1.93, 95% CI, 1.22-3.05; p D 0.005), and ICU admittance (aOR2.56, 95% CI, 1.27-5.16; p D 0.009); length of stay (aOR 1.56, 95% CI, 1.02 -2.40; p D 0.04) and cardio-respiratory resuscitation (aOR 7.75, 95% CI, 1.20 -49.98; p D 0.03). No association was observed for other comorbidities such as chronic pulmonary obstructive disease (COPD) or heart conditions in the adjusted model. Offering both pneumococcal and influenza vaccination to the elderly may improve 30-day mortality in patients with CAP.

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“…The influence of socio-economic status on incidence of LRTI has not been reported on HIV positive patients. Paradoxically, however, socio-economic status did not affect pneumonia hospitalization outcomes such as death and ICU admission, but did increase length of hospital stay and readmission rates in studies in developed countries [22–24]. This has not been reported in HIV positive patients with pneumonia.…”

Section: Discussionmentioning

confidence: 92%

Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study

et al. 2017

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Community-acquired pneumonia represents the most frequent bacterial infection in patients with HIV/AIDS. Purpose We aimed to assess variables associated with lower respiratory tract infection (LRTI) among HIV-infected adults using ART. Methods A cohort study of HIV-infected patients aged ≥18 years, enrolled from 2000 to 2015, on ART for at least 60 days, with primary outcome as the 1st episode of LRTI during follow-up. The independent variables included were sex at birth, age, race/skin color, educational level, tobacco smoking, alcohol use, cocaine use, diabetes mellitus, CD4 count, HIV viral load, influenza and pneumococcal vaccination. Extended Cox proportional hazards models accounting for time-updated variables were fitted to assess LRTI predictors. Results 2669 patients were included; median follow-up was 3.9 years per patient. LRTI was diagnosed in 384 patients; incidence rate was 30.7/1000 PY. In the unadjusted Cox extended models, non-white race [crude hazard ratio (cHR) 1.28, p = 0.020], cocaine use (cHR 2.01, p < 0.001), tobacco smoking (cHR 1.34, p value 0.007), and HIV viral load ≥400 copies/mL (cHR 3.40, p < 0.001) increased the risk of LRTI. Lower risk of LRTI was seen with higher educational level (cHR 0.61, p < 0.001), rise in CD4 counts (cHR 0.81, p < 0.001, per 100 cells/mm3 increase), influenza (cHR 0.60, p = 0.002) and pneumococcal vaccination (cHR 0.57, p < 0.001). In the adjusted model, aHR for CD4 count was 0.86, for cocaine use 1.47 and for viral load ≥400 copies 2.20. Conclusions LRTI has a high incidence in HIV-infected adults using ART. Higher CD4 counts and undetectable viral loads were protective, as were pneumococcal and influenza vaccines.

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Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study

Cited by 17 publications

References 25 publications

Pneumonia Severity Index (Psi); Assessment of Patient’s Profiles and the Length of Stay in Hospitalized Community Acquired Pneumonia Patient in Different Hospital Setting in Karachi

Pneumonia Severity Index (Psi); Assessment of Patient’s Profiles and the Length of Stay in Hospitalized Community Acquired Pneumonia Patient in Different Hospital Setting in Karachi

Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons

Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study

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