Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA.
Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA.
Respir Med. 2021 Aug-Sep;185:106476. doi: 10.1016/j.rmed.2021.106476. Epub 2021 May 21.
Increasing evidence suggests the impact of pneumonia persists beyond hospital discharge and the acute phase of respiratory symptoms. We characterized short-term and long-term risks of mortality and hospital readmission across the adult age span and spectrum of comorbidities.
Retrospective cohort design and Optum's de-identified Integrated Claims-Clinical dataset (2012-2018) were employed. Study population comprised adults who had ≥1 pneumonia hospitalization; each hospitalization ≥365 days apart was considered. Cumulative risks of all-cause mortality (from pneumonia hospitalization through 360-day post-discharge period) and all-cause hospital readmission (during 360-day post-discharge period) were summarized on an overall basis as well as by age and comorbidity profile (i.e., healthy, at-risk, high-risk).
Study population totaled 37,006 patients who contributed 38,809 pneumonia hospitalizations; mean age was 71 years, 51% were female, and 88% had at-risk (33%) or high-risk (55%) conditions. Mortality was 3.5% in hospital, 8.2% from admission to 30 days post-discharge, and 17.7% from admission to 360 days post-discharge. Hospital readmission was 12.5% during the 30-day post-discharge period, and 42.3% during the 360-day post-discharge period. Mortality risk increased with age and severity of comorbidity profile; readmission risk was highest for persons aged 65-74 years and persons with high-risk conditions.
All-cause mortality up to 1 year following pneumonia hospitalization was substantial, and was associated with increasing age and worsening comorbidity profile. Both readmission and mortality were greater at all ages in at-risk and high-risk subgroups (vs. healthy counterparts). Strategies that prevent pneumonia and/or associated pathophysiologic changes, especially among individuals with comorbidities, have the potential to reduce morbidity and mortality.
越来越多的证据表明，肺炎的影响不仅持续到出院后和呼吸道症状的急性期。我们描述了整个成年期和各种合并症范围内的短期和长期死亡风险和再入院风险。
采用回顾性队列设计和 Optum 的去识别综合索赔-临床数据集（2012-2018 年）。研究人群包括至少有 1 次肺炎住院的成年人；每次住院间隔至少 365 天。在整个研究期间以及按年龄和合并症情况（即健康、有风险、高风险）总结了全因死亡率（从肺炎住院到出院后 360 天期间）和全因再入院率（出院后 360 天期间）的累积风险。
研究人群总计 37006 例，共发生 38809 例肺炎住院；平均年龄为 71 岁，51%为女性，88%有有风险（33%）或高风险（55%）的合并症。住院死亡率为 3.5%，出院后 30 天内死亡率为 8.2%，出院后 360 天内死亡率为 17.7%。出院后 30 天内再入院率为 12.5%，出院后 360 天内再入院率为 42.3%。死亡率随年龄和合并症严重程度的增加而增加；再入院风险在 65-74 岁年龄组和高风险组中最高。
肺炎住院后 1 年内的全因死亡率相当高，且与年龄的增加和合并症严重程度的增加有关。在所有年龄组中，有风险和高风险亚组（与健康对照组相比）的再入院率和死亡率都更高。预防肺炎和/或相关病理生理变化的策略，特别是在有合并症的人群中，有可能降低发病率和死亡率。
