Program Schedule

1733
Incidence of Community-Acquired Pneumonia in the Veterans Health Administration, 2011

Session: Poster Abstract Session: Public Health
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • 1733_McLaughlin_IDWeek.pdf (365.5 kB)
  • Background:

    Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality. 

    Methods:

    Incidence rates (IR) of adult CAP in the national Veterans Health Administration (VHA) population in 2011 by age and risk status were determined using data from the VHA corporate data warehouse.  Cases were defined as a pneumonia diagnosis (ICD9 480-487) with a procedural claim for chest x-ray.  Community-acquired cases were those without prior (90 days) mechanical ventilation, long-term care, hospitalization, pneumoconiosis, or wound care.  Low, moderate, and high risk were defined as immunocompetent without chronic medical conditions, immunocompetent with ≥1 chronic medical condition, and immunocompromised, respectively.    

    Results:

    Most Veterans aged 50-64 (53%) and aged ≥65 (66%) had ≥1 chronic medical or immunocompromising condition.  In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years.  Median age of CAP patients was 65 years (95% male).  Incidence rates were higher for those aged ≥50 vs 18-49.  Compared to those at low risk, moderate- and high-risk patients were >3 and >6 times more likely to develop CAP, respectively (Figure).  Older CAP patients and those at moderate or high risk were more likely to be hospitalized and die (Table).  Percentage of CAP patients who were hospitalized was 45%, ranging from 12% (aged 18-49 at low risk) to 57% (aged ≥65 at high risk).  One-year all-cause mortality rates ranged from 1% (aged 18-49 at low risk) to 36% (aged ≥65 at high risk).

    Conclusion:

    In 2011, >35,000 CAP cases occurred in the VHA.  More than half of Veterans aged ≥50 and nearly two-thirds of Veterans aged ≥65 had ≥1 chronic medical or immunocompromising condition, and these conditions were associated with several fold higher risk of CAP.  Surprisingly, Veterans aged 50-64 had risk status-specific CAP incidence rates similar to those aged ≥65.  A focus on CAP prevention and the management of modifiable risk factors among those with comorbid or immunocompromising conditions is important, as patients at moderate or high risk for developing CAP were more likely to be hospitalized and die.    

     

    18-49

    50-64

    ≥65

    Risk Status

    % hospitalized

    % died

    % hospitalized

    % died

    % hospitalized

    % died

    Low

    12

    1

    26

    3

    42

    10

    Moderate

    20

    4

    42

    8

    55

    26

    High

    34

    17

    50

    21

    57

    36

     

    John Mclaughlin, PhD, MSPH1, Maribeth Johnson, MS2,3, Stephen Kagan, MD, FACP1 and Stephanie Baer, MD2,3, (1)Pfizer Vaccines, Collegeville, PA, (2)Georgia Regents University, Augusta, GA, (3)Charlie Norwood VA Medical Center, Augusta, GA

    Disclosures:

    J. Mclaughlin, Pfizer Inc: Employee, Salary

    M. Johnson, None

    S. Kagan, Pfizer Inc: Employee, Salary

    S. Baer, None

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