Academic Respiratory Unit, University of Bristol, Bristol, UK
Bristol Vaccine Centre, University of Bristol, Bristol, UK.
BMJ Open. 2022 Jun 15;12(6):e057464. doi: 10.1136/bmjopen-2021-057464.
To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.
Single-centre, secondary care hospital, Bristol, UK.
We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice's denominator contribution calculated based on practice population and per cent of the practices' hospitalisations admitted to the study hospital.
Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions.
The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK.
Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65-74 (3684 per 100 000 adults), 75-84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results.
The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection.
确定英国布里斯托尔住院成人急性下呼吸道疾病（aLRTD）及其亚组（肺炎、下呼吸道感染（LRTI）和心力衰竭）的疾病负担。
英国布里斯托尔的单中心二级保健医院。
我们使用两种方法估计英国布里斯托尔成人（≥18 岁）的 aLRTD 住院发病率。首先，通过回顾性国际疾病分类第 10 版（ICD-10）前五位/住院代码分析（2018 年 3 月至 2019 年 2 月）确定 aLRTD 事件。其次，在为期 21 天的前瞻性审查期间（2019 年 8 月 19 日至 9 月 9 日），根据诊断对 aLRTD 入院进行分类，并随后按年度进行分类。使用链接的全科医生和住院数据计算医院的收容人数，根据实践人群和实践住院人数占研究医院住院人数的百分比计算每个实践的收容人数。
前瞻性审查：筛选了 1322 名成年人；410 名患有 aLRTD。回顾性审查：7727 名成年患者入院。
英国布里斯托尔南米德医院成人人群中 aLRTD 及其亚组的发病率。
根据 ICD-10 代码分析，每 10 万人的年发病率为：aLRTD，1901；肺炎，591；LRTI，739；心力衰竭，402。65-74 岁（每 10 万人中有 3684 人）、75-84 岁（每 10 万人中有 6962 人）和≥85 岁（每 10 万人中有 11430 人）人群中 aLRTD 发病率最高。在前瞻性审查期间，410/1322（31%）住院成年人有 aLRTD 体征/症状，年度发病率与回顾性分析结果非常吻合。
aLRTD 疾病负担很高，随年龄急剧增加。由于指定呼吸道特异性症状或影像学改变的标准、仅使用第一个诊断代码以及病例计数来源与人口基数不匹配，aLRTD 的发病率可能高于先前估计。这可能对医疗保健规划产生重大影响，包括当前和未来针对呼吸道感染的疫苗的使用。
