487. Incidence of Community-Acquired Pneumonia in the Outpatient Setting of the Veterans Health Administration, 2011
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 487_IDWPOSTER.pdf (241.1 kB)
  • Background:

    Community-acquired pneumonia (CAP) is a significant cause of mortality and morbidity.  Though an estimated 25%-40% of CAP episodes require hospitalization, CAP is often initially managed outside the hospital.

    Methods:

    Incidence rates (IR) of adult (age ≥18) outpatient CAP in the national Veterans Health Administration (VHA) population in 2011 by age and risk of developing CAP were determined using data from the VHA corporate data warehouse.  Low, moderate, and high risk were defined as immunocompetent without chronic medical conditions, immunocompetent with ≥1 chronic medical condition, and immunocompromised, respectively.  Cases were identified from outpatient medical claims as a pneumonia diagnosis with an accompanying chest x-ray within 14 days.  To characterize cases as community-acquired, we excluded those with prior (90 days) mechanical ventilation, long-term care, hospitalization, pneumoconioses, or wound care therapy. 

    Results:

    In 2011, there were 10,566 cases of outpatient CAP during 5,811,676 person-years in the VHA.  CAP rates increased with older age (p-trend<.01) and elevated risk status (p-trend<.01) (Table).  Effect of increasing age was most pronounced among those at moderate risk.  The large majority (81%) of Veterans had ≥1 risk factor for developing CAP.  Among Veterans aged 18-49, 50-64, and ≥65, respectively, 53%, 77%, and 86% had ≥1 chronic medical or immunocompromising condition.

    Age Group

    (%)

    Low Risk

    Moderate Risk

    High Risk

    Overall

     

     

    IRs are outpatient CAP cases per 100,000 person-years

    18-49   

    (20)

    62.0

    64.6

    162.5

    69.9

    50-64   

    (42)

    88.5

    141.8

    273.3

    151.6

    65-79   

    (28)

    117.9

    183.9

    345.6

    219.4

    ≥80      

    (10)

    193.1

    356.5

    624.7

    417.7

     

     

     

     

     

     

    Conclusion:

    Given that >80% of adult Veterans had ≥1 chronic medical or immunocompromising condition and that chronic medical and immunocompromising conditions were associated with 2-4 times the risk of developing outpatient CAP, better universal prevention strategies should be identified.  In 2011, >10,000 CAP cases occurred in the VHA outpatient setting alone.  Future research, currently underway, will examine inpatient incidence of CAP, as outpatient-only incidence rates likely underestimate the overall incidence—especially in a population with disproportionately high rates of comorbid disease.

    John M. Mclaughlin, PhD, MSPH1, Kristina Kintziger, PhD, MPH2,3, Stephen Kagan, MD, FACP1 and Stephanie Baer, MD3,4, (1)Pfizer Specialty Care Medicines Development Group, Collegeville, PA, (2)Georgia Health Sciences University, Augusta, GA, (3)Charlie Norwood Vet., Augusta, GA, (4)Georgia Regents University, Augusta, GA

    Disclosures:

    J. M. Mclaughlin, Pfizer, Inc.: Employee and Shareholder, Salary

    K. Kintziger, Pfizer, Inc.: Grant Investigator, Research support

    S. Kagan, Pfizer, Inc.: Employee, Salary

    S. Baer, Pfizer, Inc.: Grant Investigator, Research support

    See more of: Public Health
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.