Kaplan Vladimir, Angus Derek C, Griffin Martin F, Clermont Gilles, Scott Watson R, Linde-Zwirble Walter T
Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Am J Respir Crit Care Med. 2002 Mar 15;165(6):766-72. doi: 10.1164/ajrccm.165.6.2103038.
Community-acquired pneumonia (CAP) is a frequent cause of hospital admission and death among elderly patients, but there is little information on age- and sex-specific incidence, patterns of care (intensive care unit admission and mechanical ventilation), resource use (length of stay and hospital costs), and outcome (mortality). We conducted an observational cohort study of all Medicare recipients, aged 65 years or older, hospitalized in nonfederal U.S. hospitals in 1997, who met ICD-9-CM-based criteria for CAP. We identified 623,718 hospital admissions for CAP (18.3 per 1,000 population > or = 65 years), of which 26,476 (4.3%) were from nursing homes and of which 66,045 (10.6%) died. The incidence rose five-fold and mortality doubled as age increased from 65-69 to older than 90 years. Men had a higher mortality, both unadjusted (odds ratio [OR]: 1.21 [95% CI: 1.19-1.23]) and adjusted for age, location before admission, underlying comorbidity, and microbiologic etiology (OR: 1.15 [95% CI: 1.13-1.17]). Mean hospital length of stay and costs per hospital admission were 7.6 days and $6,949. For those admitted to the intensive care unit (22.4%) and for those receiving mechanical ventilation (7.2%), mean length of stay and costs were 11.3 days and $14,294, and 15.7 days and $23,961, respectively. Overall hospital costs were $4.4 billion (6.3% of the expenditure in the elderly for acute hospital care), of which $2.1 billion was incurred by cases managed in intensive care units. We conclude that in the hospitalized elderly, CAP is a common and frequently fatal disease that often requires intensive care unit admission and mechanical ventilation and consumes considerable health care resources. The sex differences are of concern and require further investigation.
社区获得性肺炎（CAP）是老年患者住院和死亡的常见原因，但关于年龄和性别特异性发病率、护理模式（重症监护病房入住和机械通气）、资源使用（住院时间和住院费用）以及结局（死亡率）的信息却很少。我们对1997年在美国非联邦医院住院的所有65岁及以上医疗保险受益患者进行了一项观察性队列研究，这些患者符合基于ICD-9-CM的CAP标准。我们确定了623,718例CAP住院病例（每1000名65岁及以上人群中有18.3例），其中26,476例（4.3%）来自疗养院，66,045例（10.6%）死亡。随着年龄从65 - 69岁增加到90岁以上，发病率增加了五倍，死亡率翻了一番。男性死亡率更高，未调整时（优势比[OR]：1.21 [95%置信区间：1.19 - 1.23]），在调整年龄、入院前地点、潜在合并症和微生物病因后（OR：1.15 [95%置信区间：1.13 - 1.17]）。平均住院时间和每次住院费用分别为7.6天和6949美元。对于入住重症监护病房的患者（22.4%）和接受机械通气的患者（7.2%），平均住院时间和费用分别为11.3天和14,294美元，以及15.7天和23,961美元。总体住院费用为44亿美元（占老年人急性医院护理支出的6.3%），其中21亿美元由在重症监护病房管理的病例产生。我们得出结论，在住院老年人中，CAP是一种常见且往往致命的疾病，常常需要入住重症监护病房和进行机械通气，并消耗大量医疗资源。性别差异令人关注，需要进一步调查。
