Studying the burden of community-acquired pneumonia in adults aged ⩾50 years in primary health care: an observational study in rural Crete, Greece

Abstract

Background:Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities.Aims:The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants.Methods:An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece. Eligible patients were those aged 50 years or above, presenting with CAP based on signs and symptoms and positive X-ray findings.Results:A total of 124 CAP cases were recorded, 40 of which (32.3%) were hospitalised. Τhe age-standardised CAP incidence was estimated to be 236.7 cases per 100,000 persons aged ⩾50 years. Forty-three patients (35.2%) were vaccinated against pneumococcus. The most frequent chronic illnesses were heart disease (64.5%), chronic obstructive pulmonary disease (32.5%), and type 2 diabetes (21%). Hospitalisation determinants included advanced age (⩾74 years, Odds ratio (OR) 7.13; P value=0.001; 95% confidence interval (CI), 2.23–22.79), obesity (OR 3.36, P=0.037; 95% CI, 1.08–10.52), ⩾40 pack-years of smoking (OR 3.82, P value=0.040; 95% CI, 1.07–18.42), presence of multimorbidity (OR 5.77, P value=0.003; 95% CI, 1.81–18.42) and pneumococcal vaccination (OR 0.29, P value=0.041; 95% CI, 0.09–0.95).Conclusions:This study highlighted patient characteristics and aspects of CAP epidemiology in the context of a rural primary care setting in southern Europe where limited data have been published until now.

Prospective, Population-Based Surveillance of the Burden of Streptococcus pneumoniae in Community-Acquired Pneumonia in Older Adults, Chrzanów County, Poland, 2010 to 2012

“…CAP incidence in patients aged ≥ 65 years (19.13 per 1000 residents) was similar to that found in a retrospective assessment of CAP burden in Kielce, Poland (19.4 per 1000 residents) before the introduction of a municipal PCV7 vaccination program in young children [3]. The annual incidence rate of CXR+CAP in rural Crete, Greece was 2.4 per 1000 residents, lower than that observed in the current study (12.5 per 1000), potentially due to differences in disease incidence or variations in study design/data collection [22].…”

Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study

“…CAP incidence varies considerably according to study approach, case definition, evaluated population and country with rates between <2 and >40/1000 person-years [2e11]. Generally, studies evaluating ICD-codes as CAP definition [4,5,7e9] found higher incidences (8e44 per 1000 py) than studies requiring x-ray confirmation (1.6e14 per 1000 py) [2,3,6,10,11]. Few studies reported incidence rates of outpatients with CAP; these found widely varying rates between 1.7 and 27 per 1000 py with highest rates in the US Medicare population [2,6,7,9,12,13].…”

Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review

“…These publications are summarised in online Supplementary Table S1. Of the included publications, 31 were prospective or surveillance [5,21,25,28,30,33,38,40,41,46,49 National population-based epidemiologic surveillance data for pneumonia were available from Norway [54], Portugal [58] and Spain [59,75,77]. As observed by Tichopad and colleagues [29], epidemiologic data in Central and Eastern Europe were predominantly collected from hospital settings, and there was a lack of data on outpatient CAP, with the authors instead using inpatient-to-outpatient ratios from a retrospective chart review to estimate outpatient incidence in the Czech Republic, Hungary, Poland and Slovakia.…”

“…[5,25,28,29,[35][36][37][39][40][41]46,49,51,53,55,64,69,72,84,88,89,91,93]. The lowest incidence of all-cause pneumonia was reported in Spain between 1999 and 2001 in patients aged 15-44 years…”