Incidence of Community-Acquired Lower Respiratory Tract Infections and Pneumonia among Older Adults in the United Kingdom: A Population-Based Study

Abstract

Community-acquired lower respiratory tract infections (LRTI) and pneumonia (CAP) are common causes of morbidity and mortality among those aged ≥65 years; a growing population in many countries. Detailed incidence estimates for these infections among older adults in the United Kingdom (UK) are lacking. We used electronic general practice records from the Clinical Practice Research Data link, linked to Hospital Episode Statistics inpatient data, to estimate incidence of community-acquired LRTI and CAP among UK older adults between April 1997-March 2011, by age, sex, region and deprivation quintile. Levels of antibiotic prescribing were also assessed. LRTI incidence increased with fluctuations over time, was higher in men than women aged ≥70 and increased with age from 92.21 episodes/1000 person-years (65-69 years) to 187.91/1000 (85-89 years). CAP incidence increased more markedly with age, from 2.81 to 21.81 episodes/1000 person-years respectively, and was higher among men. For both infection groups, increases over time were attenuated after age-standardisation, indicating that these rises were largely due to population aging. Rates among those in the most deprived quintile were around 70% higher than the least deprived and were generally higher in the North of England. GP antibiotic prescribing rates were high for LRTI but lower for CAP (mostly due to immediate hospitalisation). This is the first study to provide long-term detailed incidence estimates of community-acquired LRTI and CAP in UK older individuals, taking person-time at risk into account. The summary incidence commonly presented for the ≥65 age group considerably underestimates LRTI/CAP rates, particularly among older individuals within this group. Our methodology and findings are likely to be highly relevant to health planners and researchers in other countries with aging populations.

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“…This is in good agreement with populationbased data on elderly patients with community-acquired respiratory tract infections in the UK. 31 We found that the risk of dying due to infection was 22% both at two months and one year following diagnosis. This is in contrast to the study from The Medical Research Council (MRC), which showed that nearly 50% of deaths within two months were infection-related.…”

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“…Current population based data from the United Kingdom showed that the incidence of community-acquired pneumonia increases markedly with age. 13 Those aged 85e89 years had seven times more community-acquired pneumonia episodes than those aged 65e69 years. Moreover, the study, which included a total of 1.534.443 patients (all aged 65 years), revealed an increase in the overall incidence of lower respiratory tract infections as well as of communityacquired pneumonia over the study period (1997e2011).…”

“…Moreover, the study, which included a total of 1.534.443 patients (all aged 65 years), revealed an increase in the overall incidence of lower respiratory tract infections as well as of communityacquired pneumonia over the study period (1997e2011). 13 In addition to advanced age, the presence of comorbid conditions (chronic heart, renal, liver or respiratory disease) as well as chronic alcoholism and smoking are considered to be major risk factors for community-acquired pneumonia. 14 At the same time, advanced age and multimorbidity are also associated with higher risk for parapneumonic pleural empyema.…”

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“…[1][2][3][4][5][6] WHO estimates reported that LRTI, including pneumonia were the third most common cause of death globally in 2011, after ischemic heart disease and strokes. 7 In developed countries the burden of CAP among the elderly is high and CAP cases has increased over the last years partly due to an overall increase of ageing subjects aged 65 y or older and to prolonged survival of patients with chronic diseases.…”