Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study

John M. McLaughlin, Maribeth H. Johnson, Stephen A. Kagan, Stephanie L. Baer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods: CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results: 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). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50–64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18–49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18–49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion: A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.

Original languageEnglish (US)
Pages (from-to)671-680
Number of pages10
JournalInfection
Volume43
Issue number6
DOIs
StatePublished - Dec 1 2015

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Veterans Health
United States Department of Veterans Affairs
Pneumonia
Cohort Studies
Retrospective Studies
Economics
Veterans
Incidence
Long-Term Care
Health Expenditures

Keywords

  • Burden of disease
  • Community-acquired pneumonia
  • Epidemiology
  • Risk factor
  • Risk status
  • Veterans

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011 : a retrospective cohort study. / McLaughlin, John M.; Johnson, Maribeth H.; Kagan, Stephen A.; Baer, Stephanie L.

In: Infection, Vol. 43, No. 6, 01.12.2015, p. 671-680.

Research output: Contribution to journalArticle

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abstract = "Purpose: The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods: CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results: 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). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50–64 (53 {\%}) and ≥65 (66 {\%}) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 {\%}, ranging from 12 {\%} (age 18–49, low risk) to 57 {\%} (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 {\%} (age 18–49, low risk) to 36 {\%} (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion: A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.",
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AB - Purpose: The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods: CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results: 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). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50–64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18–49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18–49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion: A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.

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