Burden of hospitalized pneumonia in Hong Kong: a population-based estimation from 2011-15

Abstract

Objective To characterize the burden of hospitalized pneumonia in Hong Kong – an urban city with high population density, long life expectancy, and a rapidly ageing population – to inform targeted healthcare policies for pneumonia control in the era of global ageing. Design Population-based cross-sectional study from 2011-2015. Setting Territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Methods Patients admitted to public hospitals with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification codes (480-486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-days readmission, hospital length of stay, and healthcare costs were assessed in seven age strata. Results We identified 323 992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified: 84.2%; bacterial pneumonia: 12.3%; viral pneumonia: 2.5%; others: 1.0%) over five years. Annual incidence was 955.1 per 100 000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality and 28-days readmission risks were 13.8%, 21.6%, and 19.5%, respectively. Average hospital length of stay was 14.1 days with corresponding direct costs of $9348 per episode in the monetary value of US Dollars 2015. Individuals ≥65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths and the majority of healthcare costs. Conclusions Hospitalized pneumonia, especially in older adults, represents considerable health and economic burden in Hong Kong. Facing a global ageing population, it is important for health systems to develop multidimensional and cost-effective strategies, to prevent and manage pneumonia in older adults. Findings from this study provide a baseline estimate of the burden of pneumonia hospitalizations for further evaluation of targeted strategies for pneumonia control.