德国社区获得性肺炎的基于人群的发病率和死亡率。
Population-based incidence and mortality of community-acquired pneumonia in Germany.
机构信息
Pfizer Pharma GmbH, Berlin, Germany.
Pfizer Deutschland GmbH, Berlin, Germany.
出版信息
PLoS One. 2021 Jun 15;16(6):e0253118. doi: 10.1371/journal.pone.0253118. eCollection 2021.
BACKGROUND
Little information on the current burden of community-acquired pneumonia (CAP) in adults in Germany is available.
METHODS
We conducted a retrospective cohort study using a representative healthcare claims database of approx. 4 million adults to estimate the incidence rates (IR) and associated mortality of CAP in 2015. IR and mortality were stratified by treatment setting, age group, and risk group status. A pneumonia coded in the primary diagnosis position or in the second diagnosis position with another pneumonia-related condition coded in the primary position was used as the base cases definition for the study. Sensitivity analyses using broader and more restrictive case definitions were also performed.
RESULTS
The overall IR of CAP in adults ≥18 years was 1,054 cases per 100,000 person-years of observation. In adults aged 16 to 59 years, IR for overall CAP, hospitalized CAP and outpatient CAP was 551, 96 and 466 (with a hospitalization rate of 17%). In adults aged ≥60 years, the respective IR were 2,032, 1,061 and 1,053 (with a hospitalization rate of 52%). If any pneumonia coded in the primary or secondary diagnosis position was considered for hospitalized patients, the IR increased 1.5-fold to 1,560 in the elderly ≥60 years. The incidence of CAP hospitalizations was substantially higher in adults ≥18 years with at-risk conditions and high-risk conditions (IR of 608 and 1,552, respectively), compared to adults without underlying risk conditions (IR 108). High mortality of hospitalized CAP in adults ≥18 was observed in-hospital (18.5%), at 30 days (22.9%) and at one-year (44.5%) after CAP onset. Mortality was more than double in older adults in comparison to younger patients.
CONCLUSION
CAP burden in older adults and individuals with underlying risk conditions was high. Maximizing uptake of existing vaccines for respiratory diseases may help to mitigate the disease burden, especially in times of strained healthcare resources.
背景
目前德国成人社区获得性肺炎（CAP）的负担信息有限。
方法
我们使用约 400 万成年人的代表性医疗保健索赔数据库进行回顾性队列研究，以估计 2015 年 CAP 的发病率（IR）和相关死亡率。IR 和死亡率按治疗环境、年龄组和风险组状况进行分层。将初级诊断位置编码的肺炎或在初级位置编码的另一种与肺炎相关的病症的肺炎编码为该研究的基础病例定义。还使用更广泛和更严格的病例定义进行了敏感性分析。
结果
≥18 岁成年人的 CAP 总 IR 为每 100000 人年观察到 1054 例。在 16 至 59 岁的成年人中，CAP 总发病率、住院 CAP 和门诊 CAP 为 551、96 和 466（住院率为 17%）。≥60 岁的成年人中，相应的发病率分别为 2032、1061 和 1053（住院率为 52%）。如果将任何在初级或次要诊断位置编码的肺炎考虑为住院患者，≥60 岁的老年人的 IR 增加 1.5 倍，达到 1560。患有风险条件和高风险条件的≥18 岁成年人的 CAP 住院发生率明显更高（IR 分别为 608 和 1552），而没有潜在风险条件的成年人的 IR 为 108。≥18 岁成年人住院 CAP 的高死亡率在住院期间（18.5%）、CAP 发病后 30 天（22.9%）和 1 年（44.5%）时观察到。与年轻患者相比，老年患者的死亡率高出一倍多。
结论
老年人和有潜在风险条件的成年人的 CAP 负担很高。最大限度地利用现有的呼吸道疾病疫苗可能有助于减轻疾病负担，特别是在医疗资源紧张的时期。
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