Elsevier

Vaccine

Volume 29, Issue 3, 10 January 2011, Pages 412-416
Vaccine

The burden of hospitalisations for community-acquired pneumonia (CAP) and pneumococcal pneumonia in adults in Spain (2003–2007)

https://doi.org/10.1016/j.vaccine.2010.11.025Get rights and content

Abstract

All hospital discharges and deaths related to CAP and pneumococcal-pneumonia from adults over 50 from 2003 to 2007 in Spain were obtained. Among the 447,670 Pneumonia-all causes discharges 17% were pneumococcal pneumonia. The annual hospitalisation rate was 6.27 and 1.09 cases per 1000, respectively. 75,932 deaths for Pneumonia-all causes and 9062 for pneumococcal-pneumonia were reported. CAP and pneumococcal pneumonia are major causes of morbidity and mortality in Spain, especially in the elderly. Despite current preventive measures, no significant changes in hospitalisation, mortality and case-fatality rates were found over the study period. Future preventive measures, like vaccination, could overcome these limitations.

Introduction

Community-acquired pneumonia (CAP) is a common infection in developed countries, accounting for a large number of hospitalisations and deaths, especially among adults older than 65 years of age [1], [2], [3]. Streptococcus pneumoniae, accounts for up to 50% of the cases [4], [5] and is the major bacterial cause of adult CAP that requires hospital admission [6]. Currently, two vaccines that offer protection against pneumococcal disease are available in Spain: a 7-valent conjugate vaccine (PCV7) for children (marketed in June 2001) and a 23-valent polysaccharide vaccine (PPV-23) (marketed in July 1999) which is recommended especially for adults older than the age of 65 years (60 years in Madrid and Catalonia) and for specific groups at risk [7]. PCV7 has been available in Spain only in the private market for healthy children and the uptake has increased from 2002 onwards with reported vaccine coverage in 2006 below 50%, assuming complete vaccination schedules [8]. In October 2006, the Autonomous Region of Madrid approved its inclusion in the childhood vaccination calendar, becoming the first region in Spain to include the PCV7 in its official vaccination programme.

Despite the recognised importance of CAP in adults, information on the true burden of the disease is not well known, as suggested by the fact that incidence and mortality rates in adult populations have largely varied in different studies [9], [10]. Hospital discharge databases are useful for establishing burden, as they provide a complete record of all hospitalisations and, in general, are not subjected to the limitations of outpatient surveillance systems, such as under-diagnosis or deficiencies in reporting. Another advantage of these databases is the standardized diagnosis code lists that enable secular trend analysis of incident disease for a given population. The Spanish centralized discharge database, which includes more than 95% of hospitals of the National Health Care System (covering almost all the Spanish population), can give a reasonable approximation to the burden of pneumonia hospitalisation by age. Furthermore, this database has been shown to be a reliable tool for enumerating cases of CAP that required hospitalisation [6], [11], [12], [13].

This epidemiological retrospective survey aimed to provide population-based estimates of the burden of hospitalisation for all-cause pneumonia and pneumococcal pneumonia in adults over 50 years of age in Spain during a five-year period (2003–2007).

Section snippets

Materials and methods

This retrospective study used the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos; CMBD) maintained by the Ministry of Health. This system uses clinical codes from the Spanish version of the 9th International Classification of Diseases (Modificación Clínica Clasificación Internacional de Enfermedades; CIE-9-MC) and covers an estimated 98% of public hospitals. Compulsory health insurance covers an estimated 99.5% of the Spanish population, but even persons not

Results

A total of 447,670 hospital discharges for all-cause pneumonia (ICD 9 CM codes 480-486; any listed diagnosis position) in adults aged 50 or more were reported during the 5-year study period: 80,931 in 2003, 82,040 in 2004, 94,982 in 2005, 86,838 in 2006 and 102,879 in 2007. Differences by year were not statistically significant (p = 0.633) (Fig. 1). Mean age (SD) was 76 (SD 11) years and 63.9% (286,108 cases) were male. The average length of stay in hospital was 13 days (SD 17) and it did not

Discussion

In this first study to asses the population-based estimates of the burden of hospitalisations due to all-cause pneumonia and pneumococcal pneumonia in adults over 50 years of age in Spain, the high burden of the disease has been confirmed. The estimated incidence rates are similar to those reported in >65-year-old patients by Vila-Corcoles et al. and Ochoa-Gondar et al. in Catalunya in 2002–2005, where the incidence of hospitalisation was 10.5 cases per 1000 population older than 65 years old

Acknowledgements

To the Subdirección General del Instituto de Información Sanitaria for providing with the information in which this study is based.

References (25)

  • O. Ochoa-Gondar et al.

    The burden of community-acquired pneumonia in the elderly: the Spanish EVAN-65 study

    BMC Public Health

    (2008)
  • Grupo de trabajo de la ponencia de registro y programa de vacunas

    Enfermedad invasora por Streptococcus pneumoniae. Implicación de la vacunación con la vacuna conjugada heptavalente

    (2006)
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