Community versus academic hospital community-acquired pneumonia patients: a nested cohort study

Jennifer L Y Tsang^{1

2}, Kian Rego^{1

3}, Alexandra Binnie^{4

5

6}, Terry Lee⁷, Anne Mccarthy⁸, Juthaporn Cowan⁸, Patrick Archambault^{9

10

11

12}, Francois Lellouche¹³, Alexis F Turgeon¹⁴, Jennifer Yoon¹⁵, Francois Lamontagne¹⁶, Allison Mcgeer¹⁷, Josh Douglas¹⁸, Peter Daley¹⁹, Robert Fowler²⁰, David M Maslove²¹, Brent W Winston²², Todd C Lee²³, Karen C Tran²⁴, Matthew P Cheng²³, Donald C Vinh²³, John H Boyd^{25

26}, Keith R Walley^{25

26}, Joel Singer⁷, John C Marshall²⁷, Gregory Haljan²⁸, Fagun Jain²⁹, James A Russell^{30

31}; For CAPTIVATE Investigators

Affiliations

¹ Niagara Health Knowledge Institute, Niagara Health, St Catharines, ON, Canada.
² Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Faculty of Applied Health Sciences, Brock University, St Catharines, ON, Canada.
⁴ Critical Care Department, William Osler Health System, Brampton, ON, Canada.
⁵ Algarve Biomedical Centre, Faro, Portugal.
⁶ Centro Hospitalar Universitário do Algarve, Faro, Portugal.
⁷ Centre for Advancing Health Outcomes, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁸ Ottawa Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁹ Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Levis, Québec, Canada.
¹⁰ Faculty of Medicine, Université Laval, Québec, Québec, Canada.
¹¹ VITAM - Centre de recherche en santé durable, Québec, Québec, Canada.
¹² Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec, Canada.
¹³ Département de médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC, Canada.
¹⁴ Division of Critical Care Medicine, Faculty of Medicine, CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma- Emergency- Critical Care Medicine, and Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.
¹⁵ Humber River Hospital, Toronto, ON, Canada.
¹⁶ University of Sherbrooke, Sherbrooke, QC, Canada.
¹⁷ Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
¹⁸ Lion's Gate Hospital, North Vancouver, BC, Canada.
¹⁹ Memorial University of Newfoundland, St. John's, NL, Canada.
²⁰ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
²¹ Department of Critical Care, Kingston General Hospital and Queen's University, Kingston, ON, Canada.
²² Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
²³ Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
²⁴ Division of General Internal Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
²⁵ Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
²⁶ Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
²⁷ Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
²⁸ Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
²⁹ Black Tusk Research Group, Vancouver, BC, Canada.
³⁰ Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Jim.Russell@hli.ubc.ca.
³¹ Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Jim.Russell@hli.ubc.ca.

PMID: 39582027
PMCID: PMC11587589
DOI: 10.1186/s41479-024-00143-x

Community versus academic hospital community-acquired pneumonia patients: a nested cohort study

Jennifer L Y Tsang et al. Pneumonia (Nathan). 2024.

. 2024 Nov 25;16(1):31.

doi: 10.1186/s41479-024-00143-x.

Authors

Affiliations

¹ Niagara Health Knowledge Institute, Niagara Health, St Catharines, ON, Canada.
² Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Faculty of Applied Health Sciences, Brock University, St Catharines, ON, Canada.
⁴ Critical Care Department, William Osler Health System, Brampton, ON, Canada.
⁵ Algarve Biomedical Centre, Faro, Portugal.
⁶ Centro Hospitalar Universitário do Algarve, Faro, Portugal.
⁷ Centre for Advancing Health Outcomes, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁸ Ottawa Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁹ Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Levis, Québec, Canada.
¹⁰ Faculty of Medicine, Université Laval, Québec, Québec, Canada.
¹¹ VITAM - Centre de recherche en santé durable, Québec, Québec, Canada.
¹² Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec, Canada.
¹³ Département de médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC, Canada.
¹⁴ Division of Critical Care Medicine, Faculty of Medicine, CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma- Emergency- Critical Care Medicine, and Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.
¹⁵ Humber River Hospital, Toronto, ON, Canada.
¹⁶ University of Sherbrooke, Sherbrooke, QC, Canada.
¹⁷ Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
¹⁸ Lion's Gate Hospital, North Vancouver, BC, Canada.
¹⁹ Memorial University of Newfoundland, St. John's, NL, Canada.
²⁰ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
²¹ Department of Critical Care, Kingston General Hospital and Queen's University, Kingston, ON, Canada.
²² Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
²³ Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
²⁴ Division of General Internal Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
²⁵ Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
²⁶ Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
²⁷ Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
²⁸ Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
²⁹ Black Tusk Research Group, Vancouver, BC, Canada.
³⁰ Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Jim.Russell@hli.ubc.ca.
³¹ Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Jim.Russell@hli.ubc.ca.

PMID: 39582027
PMCID: PMC11587589
DOI: 10.1186/s41479-024-00143-x

Abstract

Background: Most Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.

Methods: This nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals. Unadjusted and adjusted analyses for age, sex and co-morbidities using logistic, Cox and censored quantile regressions were conducted.

Results: Patients in community hospitals were older (mean [SD] 75.0 [15.7] years vs. 68.3 [16.2] years; p < 0.001), were more likely to be female (49.7% vs. 41.0%, p = 0.002), and had more comorbidities (75.9% vs. 64.8%, p < 0.001). More patients in community hospitals received corticosteroids (49.2% vs. 37.4%, p < 0.001). Community hospital patients had a higher likelihood of developing acute respiratory distress syndrome (OR 3.13, 95% CI: 1.87, 5.24, p = < 0.001), and acute cardiac injury (OR 2.53, 95% CI: 1.33, 4.83, p = 0.005). In unadjusted and adjusted analyses, 28-day mortality difference did not meet statistical significance (OR 1.43, 95% CI: 0.98, 20.7, p = 0.062 and OR 1.23, 95% CI: 0.81, 1.87, p = 0.332, respective).

Conclusion: Patients with CAP in Canadian community and academic hospitals differed with respect to their age, clinical characteristics, treatments and outcomes, emphasizing the importance of including more community hospitals in clinical research studies to ensure the generalizability of results.

Keywords: Community hospital; Community-acquired pneumonia; Corticosteroids; Mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval was received from the University of British Columbia Providence Health Care Research Ethics Board (REB Number: H20-00600) and by each of the participating sites. Consent for publication: Not applicable. Competing interests: Support for CAPTIVATE was obtained from grants to J.A.R. from the Canadian Institutes of Health Research (grant number: 439993) and St. Paul’s Hospital Foundation. J.B. is a recipient of a Providence Health Care Research Scholarship. K.W. is supported by Canadian Institutes of Health Research (CIHR) Foundation Grant (FDN 154311). A.F.T. is the chairholder of the Canada Research Chair in Critical care neurology and trauma. D.C.V. is supported by the Fonds de recherche du Québec – Santé (FRQS) clinician-scientist Senior scholar award. D.C.V. has received funding support from the Jeffrey Modell Foundation, FRQS, and Canadian Institutes of Health Research. D.C.V. has served on advisory boards for: Astra Zeneca; CSL Behring; Novartis Canada; Moderna; Takeda. D.C.V. has received speaker honoraria from: CSL Behring; Merck Canada. DCV has a patent application pending (Electronic Filing System ID: 40101099) unrelated to this work. M.C. reports grants from the Canadian Institutes of Health Research during the conduct of the study and is supported by the Fonds de Recherche du Québec – Santé. M.C. reports personal fees from GEn1E Lifesciences and from nomic bio as a member of the scientific advisory board, as well as honoraria from AstraZeneca, Takeda, Merck, and Pfizer. M.C. reports research support from Cidara therapeutics, from Scynexis, Inc., and from Amplyx Pharmaceutics during the conduct of the study but outside the submitted work. M.C. is the co-founder of Kanvas Biosciences, Inc. and owns equity in the company. M.C. has pending patents, including: i) Methods for detecting tissue damage, graft versus host disease, and infections using cell-free DNA profiling, ii) Methods for assessing the severity and progression of SARS-CoV-2 infections using cell-free DNA pending.

Figures

**Fig. 1**
Kaplan-Meier survival estimates of hospitalized CAP patients in community versus academic hospitals

See this image and copyright information in PMC

References

1. Canadian Institute for Health Information. Hospital beds staffed and in operation 2020–2021. 2022. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUK....
1. DiDiodato G, DiDiodato JA, McKee AS. The research activities of Ontario’s large community acute care hospitals: a scoping review. BMC Health Serv Res. 2017;17(1):566. - PMC - PubMed
1. Baquet CR, Commiskey P, Daniel Mullins C, Mishra SI. Recruitment and participation in clinical trials: socio-demographic, rural/urban, and health care access predictors. Cancer Detect Prev. 2006;30(1):24–33. - PMC - PubMed
1. Williams CP, Senft Everson N, Shelburne N, Norton WE. Demographic and health behavior factors associated with clinical trial invitation and participation in the United States. JAMA Netw Open. 2021;4(9):e2127792. - PMC - PubMed
1. Carmen. Visible minorities now the majority in 5 B.C. cities. CBCNews; 2017. Available from: https://www.cbc.ca/news/canada/british-columbia/visible-minorities-now-t....

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Community versus academic hospital community-acquired pneumonia patients: a nested cohort study

Affiliations

Community versus academic hospital community-acquired pneumonia patients: a nested cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

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