One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System

Joe L. Hsu, Andrew M. Siroka, Mark W. Smith, Mark Holodniy, Gianfranco Meduri

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: While studies have demonstrated higher medium-term mortality for community-acquired pneumonia (CAP), mortality and costs have not been characterized for healthcare-associated pneumonia (HCAP) over a 1-year period. Methods: We conducted a retrospective cohort study to evaluate mortality rates and health system costs for patients with CAP or HCAP during initial hospitalization and for 1 year after hospital discharge. We selected 50 758 patients admitted to the Veterans Affairs (VA) healthcare system between October 2003 and May 2007. Main outcome measures included hospital, post-discharge, and cumulative mortality rates and cost during initial hospitalization and at 12 months following discharge. Results: Hospital and 1-year HCAP mortality were nearly twice that of CAP. HCAP was an independent predictor for hospital mortality (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.49-1.76) and 1-year mortality (OR 1.99, 95% CI 1.87-2.11) when controlling for demographics, comorbidities, pneumonia severity, and factors associated with multidrug-resistant infection, including immune suppression, previous antibiotic treatment, and aspiration pneumonia. HCAP patients consistently had higher mortality in each stratum of the Charlson-Deyo-Quan comorbidity index. HCAP patients incurred significantly greater cost during the initial hospital stay and in the following 12 months. Demographics and comorbid conditions, particularly aspiration pneumonia, accounted for 19-33% of this difference. Conclusion: HCAP represents a distinct category of pneumonia with particularly poor survival up to 1 year after hospital discharge. While comorbidities, pneumonia severity, and risk factors for multidrug-resistant infection may interact to produce even higher mortality compared to CAP, they alone do not explain the observed differences.

Original languageEnglish (US)
JournalInternational Journal of Infectious Diseases
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2011

Fingerprint

Community Health Services
Veterans
Pneumonia
Delivery of Health Care
Mortality
Comorbidity
Aspiration Pneumonia
Costs and Cost Analysis
Hospitalization
Odds Ratio
Demography
Confidence Intervals
Hospital Mortality
Infection
Health Care Costs

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System. / Hsu, Joe L.; Siroka, Andrew M.; Smith, Mark W.; Holodniy, Mark; Meduri, Gianfranco.

In: International Journal of Infectious Diseases, Vol. 15, No. 6, 01.06.2011.

Research output: Contribution to journalArticle

@article{b108dd633d154c84bc41299d80da222f,
title = "One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System",
abstract = "Background: While studies have demonstrated higher medium-term mortality for community-acquired pneumonia (CAP), mortality and costs have not been characterized for healthcare-associated pneumonia (HCAP) over a 1-year period. Methods: We conducted a retrospective cohort study to evaluate mortality rates and health system costs for patients with CAP or HCAP during initial hospitalization and for 1 year after hospital discharge. We selected 50 758 patients admitted to the Veterans Affairs (VA) healthcare system between October 2003 and May 2007. Main outcome measures included hospital, post-discharge, and cumulative mortality rates and cost during initial hospitalization and at 12 months following discharge. Results: Hospital and 1-year HCAP mortality were nearly twice that of CAP. HCAP was an independent predictor for hospital mortality (odds ratio (OR) 1.62, 95{\%} confidence interval (CI) 1.49-1.76) and 1-year mortality (OR 1.99, 95{\%} CI 1.87-2.11) when controlling for demographics, comorbidities, pneumonia severity, and factors associated with multidrug-resistant infection, including immune suppression, previous antibiotic treatment, and aspiration pneumonia. HCAP patients consistently had higher mortality in each stratum of the Charlson-Deyo-Quan comorbidity index. HCAP patients incurred significantly greater cost during the initial hospital stay and in the following 12 months. Demographics and comorbid conditions, particularly aspiration pneumonia, accounted for 19-33{\%} of this difference. Conclusion: HCAP represents a distinct category of pneumonia with particularly poor survival up to 1 year after hospital discharge. While comorbidities, pneumonia severity, and risk factors for multidrug-resistant infection may interact to produce even higher mortality compared to CAP, they alone do not explain the observed differences.",
author = "Hsu, {Joe L.} and Siroka, {Andrew M.} and Smith, {Mark W.} and Mark Holodniy and Gianfranco Meduri",
year = "2011",
month = "6",
day = "1",
doi = "10.1016/j.ijid.2011.02.002",
language = "English (US)",
volume = "15",
journal = "International Journal of Infectious Diseases",
issn = "1201-9712",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System

AU - Hsu, Joe L.

AU - Siroka, Andrew M.

AU - Smith, Mark W.

AU - Holodniy, Mark

AU - Meduri, Gianfranco

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: While studies have demonstrated higher medium-term mortality for community-acquired pneumonia (CAP), mortality and costs have not been characterized for healthcare-associated pneumonia (HCAP) over a 1-year period. Methods: We conducted a retrospective cohort study to evaluate mortality rates and health system costs for patients with CAP or HCAP during initial hospitalization and for 1 year after hospital discharge. We selected 50 758 patients admitted to the Veterans Affairs (VA) healthcare system between October 2003 and May 2007. Main outcome measures included hospital, post-discharge, and cumulative mortality rates and cost during initial hospitalization and at 12 months following discharge. Results: Hospital and 1-year HCAP mortality were nearly twice that of CAP. HCAP was an independent predictor for hospital mortality (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.49-1.76) and 1-year mortality (OR 1.99, 95% CI 1.87-2.11) when controlling for demographics, comorbidities, pneumonia severity, and factors associated with multidrug-resistant infection, including immune suppression, previous antibiotic treatment, and aspiration pneumonia. HCAP patients consistently had higher mortality in each stratum of the Charlson-Deyo-Quan comorbidity index. HCAP patients incurred significantly greater cost during the initial hospital stay and in the following 12 months. Demographics and comorbid conditions, particularly aspiration pneumonia, accounted for 19-33% of this difference. Conclusion: HCAP represents a distinct category of pneumonia with particularly poor survival up to 1 year after hospital discharge. While comorbidities, pneumonia severity, and risk factors for multidrug-resistant infection may interact to produce even higher mortality compared to CAP, they alone do not explain the observed differences.

AB - Background: While studies have demonstrated higher medium-term mortality for community-acquired pneumonia (CAP), mortality and costs have not been characterized for healthcare-associated pneumonia (HCAP) over a 1-year period. Methods: We conducted a retrospective cohort study to evaluate mortality rates and health system costs for patients with CAP or HCAP during initial hospitalization and for 1 year after hospital discharge. We selected 50 758 patients admitted to the Veterans Affairs (VA) healthcare system between October 2003 and May 2007. Main outcome measures included hospital, post-discharge, and cumulative mortality rates and cost during initial hospitalization and at 12 months following discharge. Results: Hospital and 1-year HCAP mortality were nearly twice that of CAP. HCAP was an independent predictor for hospital mortality (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.49-1.76) and 1-year mortality (OR 1.99, 95% CI 1.87-2.11) when controlling for demographics, comorbidities, pneumonia severity, and factors associated with multidrug-resistant infection, including immune suppression, previous antibiotic treatment, and aspiration pneumonia. HCAP patients consistently had higher mortality in each stratum of the Charlson-Deyo-Quan comorbidity index. HCAP patients incurred significantly greater cost during the initial hospital stay and in the following 12 months. Demographics and comorbid conditions, particularly aspiration pneumonia, accounted for 19-33% of this difference. Conclusion: HCAP represents a distinct category of pneumonia with particularly poor survival up to 1 year after hospital discharge. While comorbidities, pneumonia severity, and risk factors for multidrug-resistant infection may interact to produce even higher mortality compared to CAP, they alone do not explain the observed differences.

UR - http://www.scopus.com/inward/record.url?scp=79955953498&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955953498&partnerID=8YFLogxK

U2 - 10.1016/j.ijid.2011.02.002

DO - 10.1016/j.ijid.2011.02.002

M3 - Article

VL - 15

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

SN - 1201-9712

IS - 6

ER -