The findings extend our previous understanding of the social needs of patients with CAP. In one French study,10–
107 consecutive patients with CAP were evaluated, and 34 were identified as falling into a category of low socioeconomic status, which was defined as being unemployed, homeless, on government assistance, or having poor living conditions. These patients were more often substance abusers than other patients, and they had a higher incidence of tuberculosis as a cause of their infection. The overall mortality rate was lower in those of lower socioeconomic status, and severity of illness was similar to that of other patients, but their LOS was on average 6 days longer than for patients without this risk factor. Other studies11–
have reported that the cost of care is higher in urban hospitals than in rural hospitals in the United States, presumably in part because of greater care needs in disadvantaged urban patients. In examining the specific impact of social factors, Fine et al12–
have reported that a lack of patient home care support increased the likelihood of hospital admission for CAP by more than 50-fold, even in a population with a low risk of death (ie, < 5%). Similarly, for patients who are hospitalized, discharge is delayed, even in clinically stable patients, in order to make arrangements for long-term care, a provision that may be harder in patients of low socioeconomic status.13
Thus, for a number of reasons, the cost of care for economically disadvantaged patients is increased when CAP is present, even though severity of illness and outcomes are similar to those of patients without such profound social needs.