Hospital Burden of All-Cause Pneumonia and Nonbacteremic Pneumococcal Pneumonia in Adults in France Between 2013 and 2019

Abstract

Background: Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. The study objective was to describe the hospital burden of pneumonia in the adult population in France.

Methods: This retrospective study was conducted from the National Health Insurance Database. All hospitalizations for pneumonia (all-cause) between 2013 and 2019 were included. Different risk categories for patients were established based on pneumococcal vaccine recommendations by French health authorities.

Results: A total of 2 199 240 episodes of CAP were registered over the study period (annual mean, 314 177 [standard deviation, 17 818.6]); 75% occurred in patients aged ≥65 years, among whom 47% were not classified in the moderate- or high-risk categories recommended for French pneumococcal vaccination. The incidence of CAP increased with age (117.9, 395.3, and 1916.7 per 100 000 for the age groups 18-49, 50-64, and ≥65 years, respectively, in 2019). Furthermore, being at risk of pneumococcal disease resulted in more severe outcomes, including longer episode duration (mean, 14 days in low-risk vs 17 days in high-risk patients) and higher risk of referral to critical care units (from 20% to 27%), of rehospitalization up to 180 days (from 39% to 67%), of in-hospital death (from 12% to 19%), and of 1-year mortality (from 26% to 49%).

Conclusions: This study establishes the incidence of CAP in adults in France, describes the significant burden of disease, and highlights the need for better prevention policies.

Keywords: France; Streptococcus pneumoniae vaccination; mortality; pneumococcal disease; pneumonia.

Figure 1.

Prioritization of invasive pneumococcal infections. *Other invasive infections: arthritis, osteomyelitis, endocarditis, and nonrheumatic aortic valve disease (further detailed in Supplementary Table 2). Episodes of other infection were excluded from the analysis. Abbreviation: PD, pneumococcal disease.

Figure 2.

Incidence rate (per 1 000 000 inhabitants) of hospitalization episodes of all-cause pneumonia, by age and risk group in 2019 in France. Incidence rates were adjusted to account for hospitalization episodes ending in 2020.