Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh.
Global Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Lyon, France.
J Infect Dis. 2020 Oct 7;222(Suppl 7):S570-S576. doi: 10.1093/infdis/jiz053.
Pneumonia constitutes a substantial disease burden among adults overall and those who are elderly. We aimed to identify all studies investigating the disease burden among older adults (age, ≥65 years) admitted to the hospital with pneumonia. We estimated the hospital admission rate and in-hospital case-fatality ratio (CFR) of pneumonia in older adults, stratified by age and economic status (industrialized vs developing), with data from a systematic review of studies published from 1996 through 2017 and from 8 unpublished population-based studies. We applied these rate estimates to population estimates for 2015 to calculate the global and regional burden in older adults who would have been admitted to the hospital with pneumonia that year. We estimated the number of in-hospital pneumonia deaths by combining in-hospital CFRs with hospital admission estimates from hospital-based studies. We identified 109 eligible studies; 73 used clinical pneumonia as the case definition, and 36 used radiologically confirmed pneumonia as the case definition. We estimated that, in 2015, 6.8 million episodes (uncertainty range [UR], 5.8-8.0 episodes) of clinical pneumonia resulted in hospital admissions of older adults worldwide. The hospital admission rate increased with advancing age and was higher in men. The total disease burden was likely underestimated when using the definition of radiologically confirmed pneumonia. Based on data from 52 hospital studies reporting data on pneumonia mortality, we estimated that about 1.1 million in-hospital deaths (UR, 0.9-1.4 in-hospital deaths) occurred among older adults. The burden of pneumonia requiring hospitalization among older adults is substantial. Appropriate prevention and management strategies should be developed to reduce its impact.
肺炎在所有成年人和老年人中都构成了相当大的疾病负担。我们旨在确定所有研究肺炎在住院老年患者（年龄≥65 岁）中的疾病负担的研究。我们使用 1996 年至 2017 年发表的研究和 8 项未发表的基于人群的研究的系统评价数据，按年龄和经济状况（工业化与发展中）对肺炎的住院率和院内病死率（CFR）进行分层，对老年人的肺炎住院率和院内病死率进行了估计。我们将这些率估计应用于 2015 年的人口估计，以计算当年因肺炎住院的全球和区域老年人负担。我们将住院 CFR 与基于医院的研究中的住院估计相结合，计算了住院肺炎死亡人数。我们确定了 109 项符合条件的研究；其中 73 项使用临床肺炎作为病例定义，36 项使用放射学确诊肺炎作为病例定义。我们估计，2015 年，全球有 680 万例（不确定范围[UR]为 580 万至 800 万例）临床肺炎导致老年人住院。随着年龄的增长，住院率逐渐增加，且男性的住院率更高。当使用放射学确诊肺炎的定义时，总疾病负担可能被低估。基于 52 项报告肺炎死亡率数据的医院研究的数据，我们估计，老年人中有约 110 万例院内死亡（UR 为 0.9-1.4 例）。需要住院治疗的老年肺炎负担相当大。应制定适当的预防和管理策略，以减轻其影响。
