Abstract

CONTEXT
Recent reports suggest that the mortality rate of patients hospitalized with pneumonia has steadily declined. While this may be the result of advances in clinical care or improvements in quality, it may also represent an artifact of changes in diagnostic coding.
OBJECTIVE
To compare estimates of trends in hospitalizations and inpatient mortality among patients with pneumonia using 2 approaches to case definition: one limited to patients with a principal diagnosis of pneumonia, and another that includes patients with a secondary diagnosis of pneumonia if the principal diagnosis is sepsis or respiratory failure.
DESIGN, SETTING, AND PARTICIPANTS
Trends study using data from the 2003-2009 releases of the Nationwide Inpatient Sample.
MAIN OUTCOME MEASURES
Change in the annual hospitalization rate and change in inpatient mortality over time.
RESULTS
From 2003 to 2009, the annual hospitalization rate for patients with a principal diagnosis of pneumonia declined 27.4%, from 5.5 to 4.0 per 1000, while the age- and sex-adjusted mortality decreased from 5.8% to 4.2% (absolute risk reduction [ARR], 1.6%; 95% CI, 1.4%-1.9%; relative risk reduction [RRR], 28.2%; 95% CI, 25.2%-31.2%). Over the same period, hospitalization rates of patients with a principal diagnosis of sepsis and a secondary diagnosis of pneumonia increased 177.6% from 0.4 to 1.1 per 1000, while inpatient mortality decreased from 25.1% to 22.2% (ARR, 3.0%; 95% CI, 1.6%-4.4%; RRR, 12%; 95% CI, 7.5%-16.1%); hospitalization rates for patients with a principal diagnosis of respiratory failure and a secondary diagnosis of pneumonia increased 9.3% from 0.44 to 0.48 per 1000 and mortality declined from 25.1% to 19.2% (ARR, 6.0%; 95% CI, 4.6%-7.3%; RRR, 23.7%; 95% CI, 19.7%-27.8%). However, when the 3 groups were combined, the hospitalization rate declined only 12.5%, from 6.3 to 5.6 per 1000, while the age- and sex-adjusted inpatient mortality rate increased from 8.3% to 8.8% (AR increase, 0.5%; 95% CI, 0.1%-0.9%; RR increase, 6.0%; 95% CI, 3.3%-8.8%). Over this same time frame, the age-, sex-, and comorbidity-adjusted mortality rate declined from 8.3% to 7.8% (ARR, 0.5%; 95% CI, 0.2%-0.9%; RRR, 6.3%; 95% CI, 3.8%-8.8%).
CONCLUSIONS
From 2003 to 2009, hospitalization and inpatient mortality rates for patients with a principal diagnosis of pneumonia decreased substantially, whereas hospitalizations with a principal diagnosis of sepsis or respiratory failure accompanied by a secondary diagnosis of pneumonia increased and mortality declined. However, when the 3 pneumonia diagnoses were combined, the decline in the hospitalization rate was attenuated and inpatient mortality was little changed, suggesting an association of these results with temporal trends in diagnostic coding.

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Publisher Full Text

Publisher Full Text

Authors

Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB

Institution

Baystate Medical Center, 280 Chestnut St, Springfield, MA 01199, USA. peter.lindenauer@bhs.org

Source

JAMA : the journal of the American Medical Association 307:13 2012 Apr 4 pg 1405-13

MeSH

Adolescent
Adult
Aged
Aged, 80 and over
Clinical Coding
Databases, Factual
Diagnosis-Related Groups
Female
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Pneumonia
Respiratory Insufficiency
Retrospective Studies
Sepsis
United States
Young Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22474204