364. Incidence, Mortality, and Cost of Healthcare-associated and Community Acquired Pneumonia in Medicare Beneficiaries
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Background:  Pneumonia is a frequent and serious illness in the elderly, with significant impact on mortality and healthcare costs.   We calculated incidence, mortality and cost of pneumonia in elderly Medicare beneficiaries.

Methods:  Administrative claims from a five percent sample of fee-for-service Medicare beneficiaries age 65 and older, 2005 through 2007 were used (two million beneficiaries/ year). Pneumonia was identified by ICD-9 codes and classified based on American Thoracic Society / Infectious Disease Society of America as community-acquired (CAP) or health-care associated (HCAP).  Cumulative incidence and mortality by type of pneumonia was calculated. Propensity score matching was used to estimate the 12-month excess total direct medical costs for individuals hospitalized for pneumonia (primary discharge diagnosis).   


Results:  The age-adjusted annual cumulative incidence of pneumonia episodes was 47.8/1000 elderly beneficiaries.  Pneumonia increased with age, occurring in 2.9 percent of beneficiaries age 65-74, and increasing to 9.5 percent for 85+.  Hospital days per episode were 7.3 for CAP and 9.4 for HCAP (p<0.0001).  Over half (55.1%) of pneumonia episodes (including pneumonia as secondary diagnosis) included a hospitalization.  One-fourth (25.8%) of primary pneumonia hospitalizations were classified as HCAP.  Nearly half (43.0%) of pneumonia episodes in 65-74 year olds were treated in the outpatient, non-long term care setting, decreasing to a third (33.2%) by 85+.  The proportion of all primary pneumonias treated in the hospital also increased with age, from 35.2 to 41.1 percent.


Thirty-day mortality was twice as high among beneficiaries with HCAP than those hospitalized with CAP (15.5% vs. 8.2%).  One-year risk adjusted mortality was 23.6% higher in the hospitalized pneumonia population than in matched controls without pneumonia.   Total medical costs for beneficiaries during and one year following a hospitalization for pneumonia were $15,682 higher than matched controls without pneumonia.  

Conclusion:  Pneumonia in the elderly (HCAP and CAP) is associated with high incidence, and high mortality and costs during and after an acute episode.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Cindy Parks Thomas, Ph.D.1, Marian Ryan, Ph.D.2, John Chapman, Ph.D.1, William Stason, MD1, Christopher P. Tompkins, Ph.D.1, Jose A. Suaya, MD, PhD3, Daniel Polsky, Ph.D.4, David M. Mannino, MD5 and Donald S. Shepard, Ph.D.1, (1)Institute on Healthcare Systems/Schneider Institutes for Health Policy, Brandeis University, Waltham, MA, (2)Research and Development, Institute for Healthcare Advancement, La Habra, CA, (3)US Global Health Outcomes, GlaxoSmithKline, Philadelphia, PA, (4)University of Pennsylvania, Philadelphia, PA, (5)University of Kentucky, Lexington, KY


C. P. Thomas, None

M. Ryan, None

J. Chapman, None

W. Stason, None

C. P. Tompkins, None

J. A. Suaya, None

D. Polsky, None

D. M. Mannino, None

D. S. Shepard, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.