The hospitalization burden of all-cause pneumonia in China: A population-based study, 2009-2017

Abstract

Background: Pneumonia represents a public health problem of substantial health and economic burden. However, the evidence on the burden of adult pneumonia is limited in China.

Methods: The China Kadoorie Biobank recruited 512,725 participants aged 30-79 years from five urban and five rural areas during 2004-2008. The current analyses included 506,086 participants who were alive in 2009. Pneumonia hospitalizations were ascertained through the health insurance system until December 31, 2017. Generalized linear models were used to examine the secular trends and regional and population variations in pneumonia hospitalization rate, mean length of hospital stay (LOS), and 30-day case fatality rate (CFR).

Findings: A total of 27,879 participants with 36,567 pneumonia hospitalizations were identified with a mean follow-up time of 8·9 years. The unadjusted hospitalization rate was 8·4 (95% confidence interval [CI]: 8·3, 8·6) per 1000 person-years, with an increase of 15·5% annually from 4·2 (3·9, 4·4) in 2009 to 10·9 (10·6, 11·3) in 2017, after adjusting for age, sex, study area. The mean LOS was 8·8 (95% CI: 8·7, 8·9) days, with a slight decrease of 1·0% annually from 2009 to 2017. The average 30-day CFR remained practically unchanged at 2·4 (95% CI: 2·2, 2·5) deaths per 100 admissions. A clear seasonal pattern of pneumonia hospitalization rate was observed, and the hospitalization rate and CFR differed across regions and subpopulations of different ages and underlying conditions.

Interpretation: There was an increasing hospitalization burden of pneumonia in Chinese adults, especially for adults aged ≥60 years or those with underlying conditions.

Funding: The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology.

Translated abstract in chinese: This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript. :, ., .:(China Kadoorie Biobank)2004-2008555030-79.506,086200911.20091120171231.,30,.:8.9, 27,879, 36,567.8.4 (95% CI:8.3, 8.6)/1000, ,, 20094.2 (3.9, 4.4)201710.9 (10.6, 11.3), 15.5%.8.8(95% CI:8.7, 8.9), 1.0%.30, 2.4(95% CI:2.2, 2.5)/100.;,, 30.:, ≥60.

Keywords: Adult; Case fatality rate; Epidemiology; Hospitalization; Length of stay; Pneumonia.

Figure 1

Secular trends in pneumonia hospitalization from 2009 to 2017. The data were adjusted for annually updated age, sex, and study area. Age was updated at the start of each year from 2009 to 2017 in the analysis of hospitalization rate or until the occurrence of the index hospitalization in the analysis of length of hospital stay and 30-day case fatality rate. The area of each square is inversely proportional to the variance, and 95% confidence intervals are shown. Numbers alongside the squares are hospitalization rates per 1000 person-years, mean length of hospital stay in days, or case fatality rates per 100 admissions, as appropriate.

Figure 2

Variations in pneumonia hospitalization by age and the number of underlying conditions. Data were adjusted for sex, study area, and the year of the index hospital admission. Underlying conditions included hypertension, diabetes, ischemic heart disease, stroke, chronic obstructive pulmonary disease, tuberculosis, asthma, chronic kidney disease, cirrhosis/chronic hepatitis, and cancer. Age and the disease status of the above diseases were updated at the start of each year from 2009 to 2017 in the analysis of hospitalization rate or until the occurrence of the index hospitalization in the analysis of length of hospital stay and 30-day case fatality rate. The error bar represents the standard error. Numbers above the histograms are rates per 1000 person-years, mean length of stay in days, or case fatality rates per 100 admissions, as appropriate.