title: Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study.
abstract: OBJECTIVE
  The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA).
  
  
  METHODS
  CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA.
  
  
  RESULTS
  In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years. Median age of CAP patients was 65 years (95 % male). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50-64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18-49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18-49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years).
  
  
  CONCLUSIONS
  A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.
authors.affiliation: Pfizer Vaccines, New York, NY, USA. john.mclaughlin@pfizer.com.|, PO BOX 113, Powell, OH, 43065, USA. john.mclaughlin@pfizer.com.
authors.forename: John M
authors.initials: JM
authors.lastname: McLaughlin
authors.affiliation: Charlie Norwood VA Medical Center, Augusta, GA, USA.|Georgia Regents University, Augusta, GA, USA.
authors.forename: Maribeth H
authors.initials: MH
authors.lastname: Johnson
authors.affiliation: Pfizer Vaccines, New York, NY, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kagan
authors.affiliation: Charlie Norwood VA Medical Center, Augusta, GA, USA.|Georgia Regents University, Augusta, GA, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Baer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000191:economics* / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D058014:Veterans Health; D055815:Young Adult
keywords: Burden of disease; Community-acquired pneumonia; Epidemiology; Risk factor; Risk status; Veterans