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]

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

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.

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

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)

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For Level of evidence and classes click here.