title: A retrospective analysis of hospital discharge records for S. pneumoniae diseases in the elderly population of Florence, Italy, 2010-2012.
abstract: Invasive pneumococcal diseases (IPD) and community acquired pneumonia (CAP) represent two of the major causes of out-patient visits, hospital admissions and deaths in the elderly. In Tuscany (Italy), in the Local Health Unit of Florence, a project aimed at implementing an active surveillance of pneumococcal diseases in the hospitalized elderly population started in 2013. The aim of this study is to show the results of the retrospective analysis (2010-2012) on hospital discharge records (HDRs) related to diseases potentially due to S. pneumoniae, using a selection of ICD9-CM codes. All ordinary hospitalizations (primary and secondary diagnoses) of the elderly population were included (11 245 HDRs). Among a population of about 200 000 inhabitants ≥65 y, the hospitalization rate (HR) increased with increasing age and was higher in males in all age groups. Almost all hospitalizations (95%) were due to CAP, only 5% were invasive diseases. Only few cases of CAP were specified as related to S. pneumoniae, the percentage was higher in case of meningitis (100%) or septicemia (22%). In-hospital deaths over the three-year period were 1703 (case fatality rate: 15%). The risk of dying, being hospitalized for a disease potentially attributable to pneumococcus (as primary diagnosis) increased significantly with age (P < 0.001), the odds ratio (OR) per increasing age year was 1.06 (95% CI 1.05-1.07) and was higher in patients with co-existing medical conditions with respect to patients without comorbidities. Currently, an active surveillance system on S. pneumoniae diseases with the inclusion of bio-molecular tests (RT-PCR), is a key step to assess the effectiveness of the PCV13 vaccine (13-valent pneumococcal conjugate vaccine) in the elderly population after implementation of vaccination policies. The results of this study will provide the comparator baseline data for the evaluation of a possible immunization programme involving one or more cohorts of the elderly in Tuscany.
authors.affiliation: a Department of Health Sciences, University of Florence; Florence, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Bechini
authors.forename: Cristina
authors.initials: C
authors.lastname: Taddei
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.forename: Miriam
authors.initials: M
authors.lastname: Levi
authors.forename: Emilia
authors.initials: E
authors.lastname: Tiscione
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Santini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Niccolini
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Mechi
authors.forename: Donatella
authors.initials: D
authors.lastname: Panatto
authors.forename: Daniela
authors.initials: D
authors.lastname: Amicizia
authors.forename: Chiara
authors.initials: C
authors.lastname: Azzari
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonanni
authors.forename: Sara
authors.initials: S
authors.lastname: Boccalini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062665:Epidemiological Monitoring; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016019:Survival Analysis
keywords: Italy; Pneumococcal conjugate vaccine; Streptococcus pneumoniae; Tuscany; elderly; hospitalizations; immunization policies