Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011–2015
Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480–486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1 days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.
KeywordsPneumonia admission Burden of disease Healthcare resource Elderly care Population aging
We thank Dr. Hou Jing from the Department of Family Medicine and General Out-patient Clinic, Kowloon Central Cluster, Hospital Authority for her clinical advice on clinical and economic burden estimation. We acknowledge Dr. In Hye Suh from the Department of Pharmacology and Pharmacy, University of Hong Kong, for proof-reading of the manuscript.
Conception and design of the work: ICW, BJC, IFH, and EWC; data collection and analysis: XL and AWT; results interpretation: all authors; drafting the article: XL; critical revision of the article: XL, JB, BJC, IFH, and EWC; study supervision: EWC. Final approval of the version to be published: all authors.
This work was partially supported by an Investigator-Initiated Research Grant from Pfizer Corporation Hong Kong Limited (grant number: WI214458). Pfizer had no role in the study design, data collection, statistical analysis, interpretation, or writing of the manuscript. The corresponding author was responsible for the content of the manuscript and the decision to submit for publication.
Compliance with ethical standards
Ethical approval and consent to participate
The study was approved by the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference number: UW16-327). Informed patient consent was waived as the data used in this study were de-identified.
Consent for publication
EWC has received the Early Career Scheme and the General Research Fund from the Hong Kong Research Grants Council; Health and Medical Research Fund from the Food and Health Bureau of Hong Kong; internal funding from The University of Hong Kong; and research funding from Bristol-Myers Squibb, Pfizer, and Janssen, all unrelated to the current work. BJC has received research funding from Sanofi Pasteur and consulting fees from Roche, all unrelated to the current work. The other co-authors declare that they have no conflict of interest.
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