Risk factors for hospital admission in the 28 days following a community-acquired pneumonia diagnosis in older adults, and their contribution to increasing hospitalisation rates over time: a cohort study.
Risk factors for hospital admission in the 28 days following a community-acquired pneumonia diagnosis in older adults, and their contribution to increasing hospitalisation rates over time: a cohort study.
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DOI：
10.1136/bmjopen-2015-008737
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发表时间：
2015-12-01
期刊：
影响因子：
2.9
通讯作者：
Thomas SL
中科院分区：
文献类型：
--
作者：
Millett ER;De Stavola BL;Quint JK;Smeeth L;Thomas SL
确定与英格兰老年人社区获得性肺炎(CAP)后住院相关的因素，并调查这些因素如何导致随着时间的推移住院人数增加。队列研究。英国的初级和二级保健。来自临床实践研究数据链的39名 211患者，符合与医院发病统计和死亡数据相关联的资格，年龄为≥65岁，并在1998年4月至2011年3月期间至少有一次CAP发作。慢性阻塞性肺病确诊后28 天内的住院治疗(即“慢性阻塞性肺病后住院”)与各种并发症、虚弱因素、药物治疗和疫苗接种之间的关系。我们研究了这些因素在CAP后住院趋势中的作用。我们还观察了研究期间CAP后死亡率和住院时间的趋势。与住院有关的并发症有14例，虚弱因素5例，药物/疫苗接种4例(分别考虑18例、12例和7例)。慢性肺部疾病、严重肾脏疾病和糖尿病等因素与住院可能性增加有关，而最近接种流感疫苗和最近开抗生素处方等因素则降低了住院几率。尽管对这些和其他因素进行了调整，CAP后住院的平均预测概率从57%(1998-2000年)显著上升到86%(2009-2010年)。在研究期间，住院时间和28天死亡率下降。我们描述的风险因素使患者能够识别CAP后住院的可能性增加，因此需要积极的病例管理。我们的分析还提供了证据，尽管近年来并发症和脆弱因素导致CAP后住院人数增加，但这一趋势似乎在很大程度上是由服务提供和患者行为的变化推动的。
To determine factors associated with hospitalisation after community-acquired pneumonia (CAP) among older adults in England, and to investigate how these factors have contributed to increasing hospitalisations over time. Cohort study. Primary and secondary care in England. 39 211 individuals from the Clinical Practice Research Datalink, who were eligible for linkage to Hospital Episode Statistics and mortality data, were aged ≥65 and had at least 1 CAP episode between April 1998 and March 2011. The association between hospitalisation within 28 days of CAP diagnosis (a ‘post-CAP’ hospitalisation) and a wide range of comorbidities, frailty factors, medications and vaccinations. We examined the role of these factors in post-CAP hospitalisation trends. We also looked at trends in post-CAP mortality and length of hospitalisation over the study period. 14 comorbidities, 5 frailty factors and 4 medications/vaccinations were associated with hospitalisation (of 18, 12 and 7 considered, respectively). Factors such as chronic lung disease, severe renal disease and diabetes were associated with increased likelihood of hospitalisation, whereas factors such as recent influenza vaccination and a recent antibiotic prescription decreased the odds of hospitalisation. Despite adjusting for these and other factors, the average predicted probability of hospitalisation after CAP rose markedly from 57% (1998–2000) to 86% (2009–2010). Duration of hospitalisation and 28-day mortality decreased over the study period. The risk factors we describe enable identification of patients at increased likelihood of post-CAP hospitalisation and thus in need of proactive case management. Our analyses also provide evidence that while comorbidities and frailty factors contributed to increasing post-CAP hospitalisations in recent years, the trend appears to be largely driven by changes in service provision and patient behaviour.