title: Retrospective epidemiological study for the characterization of community- acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain).
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) has large impact on direct healthcare costs, especially those derived from hospitalization. This study determines impact, clinical characteristics, outcome and economic consequences of CAP in the adult (≥18 years) population attended in 6 primary-care centers and 2 hospitals in Badalona (Spain) over a two-year period.
  
  
  METHODS
  Medical records were identified by codes from the International Classification of Diseases in databases (January 1st 2008-December 31st 2009).
  
  
  RESULTS
  A total of 581 patients with CAP (55.6% males, mean age 57.5 years) were identified. Prevalence: 0.64% (95% CI: 0.5%-0.7%); annual incidence: 3.0 cases/1,000 inhabitants (95% CI: 0.2-0.5). Up to 241 (41.5%) required hospitalization. Hospital admission was associated (p<0.002) with liver disease (OR=5.9), stroke (OR=3.6), dementia (OR=3.5), COPD (OR=2.9), diabetes mellitus (OR=1.9) and age (OR=1.1 per year). Length of stay (4.4±0.3 days) was associated with PSI score (β=0.195), in turn associated with age (r=0.827) and Charlson index (r=0.497). Microbiological tests were performed in all inpatients but only in 35% outpatients. Among patients with microbiological tests, results were positive in 51.7%, and among them, S pneumoniae was identified in 57.5% cases. Time to recovery was 29.9±17.2 days. Up to 7.5% inpatients presented complications, 0.8% required ICU admission and 19.1% readmission. Inhospital mortality rate was 2.5%. Adjusted mean total cost was €2,332.4/inpatient and €698.6/outpatient (p<0.001). Patients with pneumococcal CAP (n=107) showed higher comorbidity and hospitalization (76.6%), higher PSI score, larger time to recovery and higher overall costs among inpatients.
  
  
  CONCLUSIONS
  Strategies preventing CAP, thus reducing hospital admissions could likely produce substantial costs savings in addition to the reduction of CAP burden.
authors.affiliation: Planning Management Department, Dirección de Planificación y Desarrollo Organizativo, Badalona Serveis Assistencials SA, Gaietà Soler, 6-8 entlo, 08911, Badalona, Barcelona, Spain. asicras@bsa.cat
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras-Mainar
authors.forename: Jordi
authors.initials: J
authors.lastname: Ibáñez-Nolla
authors.forename: Isabel
authors.initials: I
authors.lastname: Cifuentes
authors.forename: Pablo
authors.initials: P
authors.lastname: Guijarro
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro-Artieda
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult