Pneumonia epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]

Overview

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in African Americans than caucasians. People who are hospitalized for any reason are also at high risk for pneumonia. Following urinary tract infections, pneumonia is the second most common cause of nosocomial infections, and its prevalence is 15-20% of the total number.

Epidemiology and Demographics

Table 1. Incidence of pneumococcal infections in the United States.

Age (years)	Disease Incidence Cases/100,000 (number of cases)	Death Rate Deaths/100,000 (number of deaths)
<1	31.4 (142)	0.22 (1)
1	24.6 (112)	0.22 (1)
2-4	12.6 (171)	0.15 (2)
5-17	2.2. (111)	0.02 (1)
18-34	3.7 (261)	0.26 (18)
35-49	10.3 (670)	0.65 (42)
50-64	19.5 (1,068)	1.86 (102)
≥ 65	37.0 (1,291)	5.61 (196)
Total	12.9 (3,828)	1.22 (363)
Adapted from CDC[3]

United States of America

• It is the seventh most common cause of death in the United States
• It causes around 500,000 hospitalizations and 65,000 deaths annually.

International

• It is a common illness in all parts of the world.

Age

• It is a major cause of death among all age groups.
• In children, the majority of deaths occur in the newborn period, with over two million worldwide deaths a year.
• In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia.
• Mortality decreases with age until late adulthood; elderly individuals are particularly at risk for CAP and associated mortality.

Seasonal

• More common during winter months than during other times of the year.

Gender

• CAP occurs more commonly in males than females

Race

• More common in African Americans than caucasians.

Mortality

• Patients hospitalized with pneumonia have a mortality rate of 12-14%.

Special Considerations

• Individuals with underlying illnesses such as Alzheimer's disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia.

Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008. Obtained from CDC

Countries with the highest estimated absolute number of new cases of clinical pneumonia in children

Country	Predicted no. of new cases (millions)	Estimated incidence(e/cy)
India	43.0	0.37
China	21.1	0.22
Pakistan	9.8	0.41
Bangladesh	6.4	0.41
Nigeria	6.1	0.34
Indonesia	6.0	0.28
Ethiopia	3.9	0.35
Democratic Republic of the Congo	3.9	0.39
Viet Nam	2.9	0.35
Philippines	2.7	0.27
Sudan	2.0	0.48
Afghanistan	2.0	0.45
United Republic of Tanzania	1.9	0.33
Myanmar	1.8	0.43
Brazil	1.8	0.11
Table adapted from WHO

Africa

Country	WHO Region	Population 0–4 years!	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
			All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Algeria	AfroD	3446548	470713	34251	4697	135754	80351	53790	10297	783	7315	2251	2440	804	148
Angola	AfroD	3377576	856794	62241	9674	247099	146255	97936	18712	1613	13293	4090	20429	6733	1398
Benin	AfroD	1506408	424074	30705	5895	122303	72389	48501	9231	983	6558	2018	6281	2070	522
Burkina Faso	AfroD	2955148	1047365	76085	11826	302060	178785	119719	22874	1972	16250	5000	17933	5911	1227
Cameroon	AfroD	3054802	790160	56858	14815	227882	134880	90462	17094	2470	12143	3736	13341	4397	1463
Cape Verde	AfroD	50634	9874	691	395	2848	1686	1136	208	66	148	45	39	13	8
Chad	AfroD	2006165	678297	48155	19812	195621	115785	77827	14477	3304	10285	3164	14683	4840	2390
Comoros	AfroD	122296	38380	2769	645	11069	6552	4392	832	108	591	182	377	124	37
Equ. Guinea	AfroD	107207	16341	1144	654	4713	2789	1879	344	109	244	75	402	132	85
Gabon	AfroD	185179	36186	2579	943	10436	6177	4149	775	157	551	170	291	96	43
Gambia	AfroD	287078	79805	2667	802	23016	13623	8746	802	134	1338	412	987	171	56
Ghana	AfroD	3532887	795448	57857	8199	229407	135783	90905	17394	1367	12357	3802	7808	2573	490
Guinea	AfroD	1657883	546525	39262	10948	157618	93292	62586	11804	1826	8385	2580	7689	2534	895
Guin.–Bissau	AfroD	240350	75199	5429	1216	21687	12836	8605	1632	203	1159	357	1592	525	152
Liberia	AfroD	680701	212990	15195	5418	61426	36357	24419	4568	903	3245	999	1611	531	232
Madagascar	AfroD	3305278	1051407	76189	13932	303226	179475	120231	22906	2323	16272	5007	8004	2638	637
Mali	AfroD	2911668	932894	67350	15086	269047	159245	106745	20248	2516	14384	4426	23947	7893	2292
Mauritania	AfroD	513267	144982	10415	2904	41813	24748	16603	3131	484	2224	684	2099	692	244
Mauritius	AfroD	84433	13518	985	117	3899	2307	1544	296	20	210	65	20	7	1
Niger	AfroD	3084517	1127652	81210	20418	325215	192490	129082	24415	3405	17344	5337	19004	6264	2018
Nigeria	AfroD	26568927	7339761	513783	293590	2116787	1252897	844072	154465	48956	109729	33763	121201	39948	25767
S. Tome & P'e	AfroD	23490	5118	373	46	1476	874	585	112	8	80	25	79	26	4
Senegal	AfroD	2081483	591373	42853	7836	170552	100947	67625	12883	1307	9152	2816	4612	1520	367
Seychelles	AfroD	5623	862	63	7	248	147	98	19	1	13	4	2	1	0
Sierra Leone	AfroD	969597	315676	22866	4286	91041	53886	36101	6874	715	4883	1503	7262	2393	591
Togo	AfroD	862745	280487	20292	4082	80893	47879	32083	6101	681	4334	1333	3321	1095	288
Zimbabwe	AfroD	1692247	349031	25271	4852	100661	59580	39918	7598	809	5397	1661	2461	811	205
Botswana	AfroE	225120	47818	3347	1913	13791	8162	5499	1006	319	715	220	159	52	34
Burundi	AfroE	1184632	349477	25440	3373	100789	59656	39933	7648	562	5433	1672	7259	2393	428
Cen. Afr. Rep.	AfroE	651222	195417	13981	4538	56358	33358	22394	4203	757	2986	919	3911	1289	520
Congo	AfroE	623244	168619	12244	1959	48630	28783	19275	3681	327	2615	805	2001	659	141
Cote d'Ivoire	AfroE	2969425	985611	71421	13060	284250	168244	112707	21472	2178	15253	4693	11003	3626	875
D. Rep. Congo	AfroE	11848026	3671614	263117	80589	1058894	626745	420631	79104	13438	56194	17291	86897	28641	10986
Eritrea	AfroE	861496	208035	15163	1802	59997	35512	23766	4559	301	3238	996	2419	797	129
Ethiopia	AfroE	11931668	3367561	240540	82471	971205	574843	386005	72317	13752	51372	15807	37269	12284	5196
Kenya	AfroE	6664323	1645189	119118	22871	474473	280834	188157	35812	3814	25440	7828	17064	5624	1419
Lesotho	AfroE	274307	58335	4224	811	16824	9958	6672	1270	135	902	278	607	200	50
Malawi	AfroE	2714859	658512	47877	7004	189915	112408	75261	14394	1168	10225	3146	6932	2285	448
Mozambique	AfroE	3876419	1155781	83373	19438	333327	197292	132266	25065	3241	17806	5479	13167	4340	1307
Namibia	AfroE	286374	63796	4619	887	18399	10890	7296	1389	148	987	304	287	95	24
Rwanda	AfroE	1830654	397910	13638	3991	114757	67923	43646	4100	666	6659	2049	4145	734	236
South Africa	AfroE	5041132	705554	33436	14342	203482	120438	78749	10052	2392	11357	3494	5156	1218	583
Swaziland	AfroE	156715	28802	2091	344	8306	4916	3293	629	57	446	137	471	155	34
Uganda	AfroE	6465275	1745727	126241	25969	503468	297996	199697	37953	4330	26961	8296	21181	6981	1876
U. R. Tanzania	AfroE	8009544	2151379	156285	24291	620458	367240	245913	46986	4051	33378	10270	17467	5757	1195
Zambia	AfroE	2412190	576056	41709	8008	166135	98333	65882	12539	1335	8908	2741	6141	2024	511

America

Country	WHO Region	Population 0–4 years!	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
			All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Canada	AmroA	1884546	25275	866	271	13709	8032	6438	604	105	3774	755	27	5	2
Cuba	AmroA	569056	8208	598	79	4452	2609	2178	417	31	1140	228	63	21	4
USA	AmroA	21650217	313322	22733	3845	169946	99574	83169	15868	1489	43355	8671	799	263	59
Antigua & B'a	AmroB	7756	686	50	6	198	117	78	15	1	41	8	0	0	0
Argentina	AmroB	3385831	311588	22663	3212	89862	53188	35609	6814	536	18616	3723	952	314	60
Bahamas	AmroB	25507	2514	182	23	725	429	287	55	4	151	30	25	8	1
Barbados	AmroB	14562	1377	60	19	397	235	153	18	3	87	17	4	1	0
Belize	AmroB	36599	4795	349	46	1383	819	548	105	8	287	57	9	3	1
Brazil	AmroB	15156449	1497706	95518	14711	431938	255658	169535	28717	2453	91150	18230	3079	916	181
Chile	AmroB	1219437	88722	6448	973	25588	15145	10141	1938	162	5296	1059	145	48	10
Colombia	AmroB	4497661	488486	31421	6092	140879	83385	55372	9446	1016	29585	5917	1530	459	113
Costa Rica	AmroB	362979	37185	1272	425	10724	6348	4080	382	71	2389	478	24	4	2
Dominica	AmroB	5924	703	51	6	203	120	80	15	1	42	8	0	0	0
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia (DO NOT EDIT)

“

Many patients with HAP, VAP, and HCAP are at increased risk for colonization and infection with MDR pathogens (Level II) It is often difficult to define the exact incidence of HAP and VAP, because there may be an overlap with other lower respiratory tract infections, such as tracheobronchitis, especially in mechanically ventilated patients (Level III). The exact incidence of HAP is usually between 5 and 15 cases per 1,000 hospital admissions depending on the case definition and study population; the exact incidence of VAP is 6- to 20-fold greater than in nonventilated patients (Level II). HAP and VAP are a frequent cause of nosocomial infection that is associated with a higher crude mortality than other hospital-acquired infections (Level II). Patients with late-onset HAP and VAP are more likely to be infected with MDR pathogens and have higher crude mortality than patients with early-onset disease; patients with early-onset HAP who have recently received antibiotics or had an admission to a healthcare facility are at risk for colonization and infection with MDR pathogens (Level II). An increase in crude and attributable mortality for HAP and VAP is associated with the presence of MDR pathogens (Level II). Bacteria cause most cases of HAP, VAP, and HCAP and many infections are polymicrobial; rates are especially high in patients with ARDS (Level I). HAP, VAP, and HCAP are commonly caused by aerobic gram-negative bacilli, such as P. aeruginosa, K. pneumoniae, and Acinetobacter species, or by gram-positive cocci, such as S. aureus, much of which is MRSA; anaerobes are an uncommon cause of VAP (Level II). Rates of L. pneumophila vary considerably between hospitals and disease occurs more commonly with serogroup 1 when the water supply is colonized or there is ongoing construction (Level II). Nosocomial virus and fungal infections are uncommon causes of HAP and VAP in immunocompetent patients. Outbreaks of influenza have occurred sporadically and risk of infection can be substantially reduced with widespread effective infection control, vaccination, and use of antiinfluenza agents (Level I). The prevalence of MDR pathogens varies by patient population, hospital, and type of ICU, which underscores the need for local surveillance data (Level II). MDR pathogens are more commonly isolated from patients with severe, chronic underlying disease, those with risk factors for HCAP, and patients with late-onset HAP or VAP (Level II)

”

For Level of evidence and classes click here.