Abstract

Pneumonia constitutes a substantial disease burden among adults overall and those who are elderly. We aimed to identify all studies investigating the disease burden among older adults (age, ≥65 years) admitted to the hospital with pneumonia. We estimated the hospital admission rate and in-hospital case-fatality ratio (CFR) of pneumonia in older adults, stratified by age and economic status (industrialized vs developing), with data from a systematic review of studies published from 1996 through 2017 and from 8 unpublished population-based studies. We applied these rate estimates to population estimates for 2015 to calculate the global and regional burden in older adults who would have been admitted to the hospital with pneumonia that year. We estimated the number of in-hospital pneumonia deaths by combining in-hospital CFRs with hospital admission estimates from hospital-based studies. We identified 109 eligible studies; 73 used clinical pneumonia as the case definition, and 36 used radiologically confirmed pneumonia as the case definition. We estimated that, in 2015, 6.8 million episodes (uncertainty range [UR], 5.8–8.0 episodes) of clinical pneumonia resulted in hospital admissions of older adults worldwide. The hospital admission rate increased with advancing age and was higher in men. The total disease burden was likely underestimated when using the definition of radiologically confirmed pneumonia. Based on data from 52 hospital studies reporting data on pneumonia mortality, we estimated that about 1.1 million in-hospital deaths (UR, 0.9–1.4 in-hospital deaths) occurred among older adults. The burden of pneumonia requiring hospitalization among older adults is substantial. Appropriate prevention and management strategies should be developed to reduce its impact.

中文翻译：

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老年人肺炎住院的全球和区域负担：系统评价和荟萃分析

抽象的

肺炎在成年人和老年人中构成很大的疾病负担。我们旨在确定所有调查因肺炎入院的老年人（年龄≥65岁）的疾病负担的研究。我们根据对1996年至2017年发表的研究的系统评价以及从1996年至2017年发表的研究的系统回顾得出的数据，估算了按年龄和经济状况（工业化与发展中）分层的老年人的肺炎住院率和院内病死率（CFR）。 8项未发表的基于人群的研究。我们将这些比率估算值应用于2015年的人口估算值，以计算当年因肺炎入院的老年人的全球和区域负担。我们通过将院内病死率与基于医院的研究得出的入院率相结合，估算了院内肺炎死亡人数。我们确定了109项合格研究；73例以临床肺炎为例，36例经放射学确诊的肺炎为例。我们估计，2015年有680万例临床肺炎发作（不确定性范围[UR]，5.8-8.0次发作）导致全球老年人入院。住院率随年龄的增长而增加，男性较高。当使用放射学确诊的肺炎的定义时，总疾病负担可能被低估了。根据52项医院研究报告的肺炎死亡率数据，我们估计约有110万人在院内死亡（UR，0.9-1。老年人中发生4例院内死亡。老年人中需要住院治疗的肺炎的负担是巨大的。应制定适当的预防和管理策略以减少其影响。