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Original Research |

Burden of Adult Community-Acquired, Healthcare-Associated, Hospital-Acquired, and Ventilator-Associated Pneumonia ― New York City, 2010–2014

Rachel E. Corrado, MS; David Lee, MBA, MPH; David E. Lucero, PhD; Jay K. Varma, MD; Neil M. Vora, MD
Author and Funding Information

Disclosures

The authors report no disclosures relevant to the manuscript.

Funding Source

This investigation was supported in part by an appointment to the Applied Public Health Informatics Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by CDC Cooperative Agreement 3U38-OT000143-01S4.

1Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY

2National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control (CDC) and Prevention, Atlanta, GA

3Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC, Atlanta, GA

Corresponding author: Neil Vora, MD 42-09 28th St Long Island City, NY 11101.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.162
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Abstract

Background  Although pneumonia is a leading cause of death in New York City (NYC), limited data exist about the settings in which pneumonia is acquired across NYC. Pneumonia acquired in community settings are more likely to be preventable with vaccines and treatable with first-line antibiotics than those acquired in non-community settings. Our objective was to estimate the burden of hospitalizations associated with community-acquired (CAP)-, healthcare-associated (HCAP)-, hospital-acquired (HAP)-, and ventilator-associated (VAP) pneumonia during 2010–2014.

Methods  We performed a retrospective analysis of an all-payer reporting system of hospital discharges that included NYC residents aged ≥18 years. Pneumonia-associated hospitalizations were defined as any hospitalization that included a diagnostic code for pneumonia among any of the discharge diagnoses. Using published clinical guidelines, we classified hospitalizations into mutually exclusive categories of CAP, HCAP, HAP, and VAP and defined pneumonia acquired in the community setting as the combination of CAP and HCAP.

Results  Of 4,614,108 hospitalizations during the reporting period, 283,927 (6.2%) involved pneumonia. Among pneumonia-associated hospitalizations, 154,158 (54.3%) were CAP, 85,656 (30.2%) HCAP, 39,712 (14.0%) HAP, and 4,401 (1.6%) VAP. Death during hospitalization occurred in 7.9% of CAP-associated hospitalizations, compared with 15.7% of HCAP-associated hospitalizations, 20.7% of HAP-associated hospitalizations, and 21.6% of VAP-associated hospitalizations.

Conclusions  Most pneumonia-associated hospitalizations in NYC involve pneumonias acquired in the community setting. Only 15.6% of pneumonia-associated hospitalizations were categorized as HAP or VAP, yet these pneumonias accounted for >25% of deaths from pneumonia-associated hospitalizations. Public health pneumonia prevention efforts need to target both community and hospital settings.


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