McLaughlin John M, Johnson Maribeth H, Kagan Stephen A, Baer Stephanie L
Pfizer Vaccines, New York, NY, USA.
, PO BOX 113, Powell, OH, 43065, USA.
Infection. 2015 Dec;43(6):671-80. doi: 10.1007/s15010-015-0789-3. Epub 2015 May 17.
The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA).
CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA.
In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years. Median age of CAP patients was 65 years (95 % male). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50-64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18-49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18-49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years).
A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.
美国退伍军人健康管理局（VHA）中社区获得性肺炎（CAP）的负担情况尚未得到充分描述。
CAP被定义为有肺炎诊断且有胸部X光证据，且无既往（90天内）住院/长期护理证据。我们计算了2011年在VHA住院或门诊环境中发生的成人CAP发病率。我们还估计了VHA中因CAP住院的患者比例、出院后30天内再次入院的比例以及诊断后一年内死亡（任何原因）的比例。从VHA的角度估计了CAP诊断后90天内的增量成本。
2011年，在7739757个VHA人年中，有34101名退伍军人发生了CAP（35380例）。CAP患者的中位年龄为65岁（95%为男性）。年龄≥50岁者的CAP发病率更高。50 - 64岁（53%）和≥65岁（66%）的退伍军人中，大多数患有≥1种慢性疾病（中度风险）或免疫功能低下（高风险）疾病。与低风险（健康）人群相比，中度和高风险退伍军人发生CAP的可能性分别高出3倍和6倍以上。因CAP住院的患者比例为45%，范围从12%（18 - 49岁，低风险）到57%（≥65岁，高风险）。一年全因死亡率范围从1%（18 - 49岁，低风险）到36%（≥65岁，高风险）。VHA每年与CAP相关的医疗支出估计为7.5亿美元（65岁及以上人群为4.15亿美元）。
关注老年退伍军人以及患有合并症或免疫功能低下疾病的人群预防CAP很重要。
