Socioeconomic Position and the Incidence, Severity, and Clinical Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

Abstract

Objectives The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). Methods This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group–level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. Results The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) ( P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. Conclusions Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.

Increased Risks of Death and Hospitalization in Influenza/Pneumonia and Sepsis for Individuals Affected by Psychotic Disorders, Bipolar Disorders, and Single Manic Episodes: A Retrospective Cross-Sectional Study

“…Dementia is also a known risk factor for pneumonia [46,47]. There are also other socioeconomic and environmental differences; individuals with SMDs are more likely to be homeless, unemployed, and live in poverty, all of which may affect access to healthcare and increase the risk of infection [48][49][50][51][52][53]. Individuals with SMDs may also receive fewer and more delayed medical interventions for somatic diseases, possibly associated with discrimination and stigmatization [10,54].…”

Machine Learning in Epidemiology and Health Outcomes Research

“…This deprivation score is an aggregate score developed from US Census data (58), which can be linked to individual-level data to provide some estimates of cluster effects. It has been successfully used to assist in the prediction of hospital readmission (35) and outcomes in hospitalized patients with community-acquired pneumonia (68). Investigators have used machine learning to aggregate Web search and location data, linked with restaurant data, to identify potentially unsafe restaurants (51).…”

A Review of Racial and Ethnic Disparities in Immunizations for Elderly Adults

“…7,8 Living in a socioeconomically deprived neighborhood is also a risk factor for higher mortality among those hospitalized for pneumonia. 11 Geographic areas with higher proportions of Blacks such as the Southeastern United States have higher pneumonia related hospitalization and mortality rates in comparison to regions such as the West where there are fewer Blacks. 9,12 A substantial amount of research has focused on the persistent racial and ethnic disparities in influenza and pneumococcal vaccination rates with most of the evidence focused on African Americans.…”