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Trends in community-acquired pneumonia hospitalisations and associated cardiovascular risk in Portugal, 2010-2018
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Orientador(es)
Resumo(s)
Community-acquired pneumonia (CAP) is a major cause of hospitalisation, with substantial morbidity, mortality, and costs. We aimed to better understand CAP hospitalisations in Portugal, in terms of their trends and risk of subsequent acute cardiovascular events.
We used data on hospitalisations, comorbidities prevalence, and population. CAP hospitalisations (CAP-H) of adults (≥18y) living in mainland Portugal discharged from a public hospital in 2010-18 were identified using ICD-9/10-CM codes. In a retrospective cohort analysis, we described the frequency and incidence of CAP-H per gender, age group, comorbidity, and year of discharge. Trends in incidence were explored using joinpoint regression. For a selected subgroup with CAP-H and cardiovascular hospitalization, we then conducted a self-controlled case series (SCSS), using CAP-H as exposure (14, 28 and 91-days exposure periods) and acute cardiovascular (stroke or myocardial infarction – MI) hospitalisations as the outcome. Incidence rate ratios (IRR) were computed using a conditional Poisson regression.
We studied 469,944 CAP-H (66% aged ≥75 years; 55% male). Frequently recorded comorbidities were congestive heart failure, diabetes, and chronic pulmonary disease (19% or more). The incidence of CAP-H ranged between 7.1in 2012 and 5.6 in 2018. We identified a gradual decline in the incidence rates of CAP-H for both genders and all age groups (annual percent change: -1.50 or more). CAP-H decreased over time for patients with diabetes and AIDS/HIV, while increased for chronic renal disease patients. For the remaining 6 comorbidities, an upward trend was followed by a decreasing trend.
In SCSS, a sample of 13 494 patients (stroke: 77%, MI: 23%), mostly male (stroke: 52%, MI: 55%) and 75 years or older (stroke: 78%, MI: 70%) was analyzed. Stroke/MI hospitalisation incidence was higher following CAP-H, compared to the baseline period. Increased incidence was observed especially in the 14 days after discharge (IRR for stroke: 2.55; IRR for MI: 3.23), compared to the 28-days (stroke: 2.06; MI: 2.62), and 91-days periods (stroke: 1.37; MI: 1.75) (p<0.05).
Our findings show a decline in the incidence of CAP-H and an increased risk of cardiovascular events after a CAP-H episode. These results highlight the need for clinicians and the health system to undertake continued and coordinated efforts, to reduce CAP-H and when it cannot be avoided, to address possible cardiovascular risks.
Descrição
Trabalho distinguido com o 1.º Prémio de Comunicação Livre em Formato de Poster, na área temática de Investigação.
Palavras-chave
Hospitalisations Cardiovascular Risk Pneumonia Tendências Cuidados de Saúde Portugal