Iro M A, Goldacre M J, Goldacre R
Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; Department of Paediatric Infectious Diseases, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK.
Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Infect. 2023 Apr;86(4):309-315. doi: 10.1016/j.jinf.2023.01.040. Epub 2023 Feb 9.
To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades.
Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019.
Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively.
The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.
报告英格兰中枢神经系统（CNS）脓肿和积脓在五十年间基于人群的流行病学趋势。
利用1968年至2019年常规收集的英格兰国家医院出院记录、死亡率记录和年度人口分母，对特定年龄和性别的住院率及死亡率进行趋势分析。
在20世纪80年代末之前，英格兰中枢神经系统脓肿和积脓的住院率保持稳定。在研究期的最后二十年（1999 - 2019年），首次住院率从1999年的每10万人1.24例（95%置信区间[CI] 1.14 - 1.35）增至2019年的2.86例（95% CI 2.72 - 3.01）。婴儿和老年人的住院率最高，男性高于女性。在考虑人口老龄化因素后，研究期的最后二十年中枢神经系统脓肿和积脓的年死亡率虽有小幅但显著的上升，但仍维持在较低水平，约为每10万人0.1 - 0.2例。死亡率随年龄增长而上升；儿童期死亡极为罕见。将相关诊断记录为根本原因或促成原因的病死率分别为4.3%和9.7%。
英格兰中枢神经系统脓肿和积脓的增加可能反映了病例确诊率的提高，但也应考虑发病率真正上升的可能性。
