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August 11, 1997

Incidence of Community-Acquired Pneumonia Requiring Hospitalization: Results of a Population-Based Active Surveillance Study in Ohio

Arch Intern Med. 1997;157(15):1709-1718. doi:10.1001/archinte.1997.00440360129015

Background:  Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined.

Methods:  We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia. Information about risk factors, symptoms, and outcome was collected through interview and medical chart review. Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests.

Results:  The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100 000 population; the overall case-fatality rate was 8.8%. Pneumonia incidence was higher among blacks than whites (337.7/100 000 vs 253.9/ 100 000; P<.001), was higher among males than females (291.4 vs 244.8; P<.001), and increased with age (91.6/100 000 for persons aged <45 years, 277.2/ 100 000 for persons aged 45-64 years, and 1012.3/ 100 000 for persons aged ≥65 years; P<.001). Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485 000. These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18 000), Mycoplasma pneumoniae (18 700-108 000), and Chlamydia pneumoniae (5890-49 700).

Conclusions:  These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia. The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.Arch Intern Med. 1997;157:1709-1718

National Center for Health Statistics.  Vital Statistics of the United States, 1989, Vol II: Mortality, Part A . Washington, DC: Public Health Service; 1993. US Dept of Human and Health Services publication (PHS) 93:1101.
Garibaldi RA.  Epidemiology of community-acquired respiratory tract infections in adults: incidence, etiology, and impact .  Am J Med. 1985;78( (suppl 6B) ):32-37.Crossref
Gable CB, Holzer SS, Engelhart L, et al.  Pneumococcal vaccine efficacy and associated cost savings .  JAMA. 1990;264:2910-2915.Crossref
US Department of Commerce.  1990 Census of Population, General Population Characteristics , Ohio. Washington, DC: US Dept of Commerce, Bureau of the Census; 1990. Publication 1990 CP-1-37.
Friede A, Reid JA, Ory HW.  WONDER: CDC's Online Public Health Information System . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control; 1990.
Wilkinson HW, Cruce DD, Broome CV.  Validation of Legionelle pneumophila indirect immunofluorescence assay with epidemic sera .  J Clin Microbiol. 1981; 13:139-146.
Thacker WL, Talkington DF.  Comparison of two rapid commercial tests with complement fixation for serologic diagnosis of Mycoplasma pneumoniae infections .  J Clin Microbiol. 1995;33:1212-1214.
Grayston JT, Kuo CC, Wang SP, Altman J.  A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections .  N Engl J Med. 1986;315:161-168.Crossref
Richardson LS, Yoken RH, Belshe RB, Camargo E, Kim HW, Chanock RM.  Enzyme-linked immunosorbent assay for measurement of serological response to respiratory syncytial virus infection .  Infect Immun. 1978;20:660-664.
Wilkinson H.  Hospital-Laboratory Diagnosis of Legionelle Infections . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Diseases Control; 1988.
Kohler RB, Zimmerman SE, Wilson E, et al.  Rapid radioimmunoassay diagnosis of Legionnaires' disease .  Ann Intern Med. 1981;94:601-605.Crossref
SAS Institute Inc. SAS User's Guide: Basics, Version 6. Cary, NC: SAS Institute Inc; 1990.
Breslow NE, Day NE.  Statistical Methods in Cancer Research: Volume II—The Design and Analysis of Cohort Studies . Lyon, France: International Agency for Research on Cancer; 1987:51-60.
Bartlett JG, Mundy LM.  Community-acquired pneumonia .  N Engl J Med. 1995; 333:1618-1624.Crossref
National Center for Health Statistics.  Inpatient Utilization of Short-Stay Hospitals by Diagnosis: US 1982 Annual Summary: USDHHS Data From the National Health Survey , Series 13, No. 72. Washington, DC: National Center for Health Statistics; 1982. Publication PHS-83-1733.
Centers for Disease Control and Prevention.  Update: influenza activity—United States and worldwide, and the composition of the 1991-92 influenza vaccine .  MMWR Morb Mortal Wkly Rep. 1991;40:231-232, 239-240.
Kent JH, Chapman LE, Schmeltz LM, Regnery HL, Cox NJ, Schonberger LB.  Influenza surveillance—United States, 1991-1992 .  MMWR Morb Mortal Wkly Rep. 1992;41( (SS-5) ):35-43.
Foy HM, Cooney MK, Allan I, Kenny GE.  Rates of pneumonia during influenza epidemics in Seattle, 1964 to 1975 .  JAMA. 1979;241:253-258.Crossref
Benson V, Marano MA.  Current estimates from the National Health Interview Survey, 1993—National Center for Health Statistics .  Vital Health Stat 10 ( (190) ). 1994: 13-15.
Foy HM, Kenny GE, Cooney MK, Allan ID.  Long-term epidemiology of infections with Mycoplasma pneumoniae .  J Infect Dis. 1979;139:681-687.Crossref
Jokinen C, Heiskanen L, Juvonen H, et al.  Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland .  Am J Epidemiol. 1993;137:977-988.
Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG.  Prospective study of the aetiology and outcome of pneumonia in the community .  Lancet. 1987; 1:671-674.Crossref
Breiman RF, Spika JS, Navarro BJ, Darden PM, Darby DP.  Pneumococcal bacteremia in Charleston County, South Carolina: a decade later .  Arch Intern Med. 1990;150:1401-1405.Crossref
Farley MM, Harvey RC, Stull T, et al.  A population-based assessment of invasive disease due to group B streptococcus in non-pregnant adults .  N Engl J Med. 1993; 328:1807-1811.Crossref
Fine MJ, Smith DN, Singer DE.  Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study .  Am J Med. 1990;89:713-721.Crossref
Plouffe JF, File TM, Breiman RD, et al.  Reevaluation of the definition of Legionnaires' disease: use of the urinary antigen assay .  Clin Infect Dis. 1995;20:1286-1291.Crossref
Kenny GE, Kaiser GG, Cooney MK, Foy HM.  Diagnosis of Mycoplasma pneumoniae pneumonia: sensitivities and specificities of serology with lipid antigen and isolation of the organisms on soy peptone medium for identification of infections .  J Clin Microbiol. 1990;28:2087-2093.
Bennett NM, Buffington J, LaForce FM.  Pneumococcal bacteremia in Monroe County, New York .  Am J Public Health. 1992;82:1513-1516.Crossref
Marrie TJ.  Community-acquired pneumonia .  Clin Infect Dis. 1994;18:501-515.Crossref
Thorsteinsson SB, Musher DM, Fagan T.  The diagnostic value of sputum culture in acute pneumonia .  JAMA. 1975;233:894-895.Crossref
Barrett-Connor E.  The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia .  Am Rev Respir Dis. 1971;103:845-848.
Austrian R, Gold J.  Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia .  Ann Intern Med. 1964;60:759-776.Crossref
Laurenzi GA, Potter RT, Kass EH.  Bacteriologic flora of the lower respiratory tract .  N Engl J Med. 1961;265:1273-1278.Crossref
Musher DM, Kubitschek KR, Crennan J, Baughn RE.  Pneumonia and acute febrile tracheobronchitis due to Hemophilus influenzae .  Ann Intern Med. 1983;99:444-450.Crossref
Bartlett JG.  IDCP guidelines: lower respiratory tract infections .  Infect Dis Clin Pract. 1996;5:147-167.Crossref
Fang GD, Fine M, Orloff J, et al.  New and emerging etiologies for community-acquired pneumonia with implications for therapy, a prospective multicenter study of 359 cases .  Medicine. 1990;69:307-316.Crossref
Marrie TJ, Durant H, Yates L.  Community-acquired pneumonia requiring hospitalization: 5-year prospective study .  Rev Infect Dis. 1989;11:586-599.Crossref
Niederman MS, Bass JB, Campbell GD, et al.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy .  Am Rev Respir Dis. 1993;148:1418-1426.Crossref
Marston BJ, Lipman HB, Breiman RF.  Surveillance for Legionnaires' disease: risk factors for morbidity and mortality .  Arch Intern Med. 1994;154:2417-2422.Crossref
Harrington RD, Hooton TM, Hackman RC, et al.  An outbreak of respiratory syncytial virus in a bone marrow transplant center .  J Infect Dis. 1992;165:987-993.Crossref
Falsey AR, Walsh EE, Betts RF.  Serologic evidence of respiratory syncytial virus infection in nursing home patients .  J Infect Dis. 1990;162:568-569.Crossref
Schwarzmann SW, Adler JL, Sullivan RJ.  Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969 .  Arch Intern Med. 1971;127:1037-1041.Crossref
Institute of Medicine.  Emerging Infections: Microbial Threats to Health in the United States . Washington, DC: National Academy Press; 1992.
Fedson DS.  Influenza and pneumococcal immunization strategies for physicians .  Chest. 1987;91:436-443.Crossref
Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR.  Pneumococcal polysaccharide vaccine efficacy .  JAMA. 1993;270:1826-1831.Crossref
Horwitz MA, Marston BJ, Broome CV, Breiman RF.  Prospects for vaccine development . In: Barbaree JM, Breiman RF, Dufour AP, eds.  Legionella: Current Status and Emerging Perspectives 1993 . Washington, DC: American Society for Microbiology; 1993:296-297.