Abstract
Objectives
Short-term rehospitalization and mortality are common events in older patients after
a pneumonia admission, yet little knowledge exists on how to identify the patients
at risk of these events. This knowledge is needed to ensure that health care attention
is given to those with the highest needs. We therefore aimed to identify factors of
importance for short-term rehospitalization and mortality in older patients after
admission for pneumonia.
Design
Population-based cohort study.
Setting
The Danish nationwide registries.
Participants
In total, 246,245 individuals aged 65-99 years who experienced 298,564 admissions
for pneumonia from 2000 to 2016.
Methods
The explored factors in patients were demographic characteristics, health-seeking
behavior, comorbidity, and medication use. A Cox proportional hazards model was used
to calculate hazard ratios (HRs) for 30-day rehospitalization and 30-day mortality
with 95% confidence intervals (CIs).
Results
Of the 298,564 admissions for pneumonia, 23.0% were rehospitalized and 8.1% died within
30 days of follow-up. Most of the investigated factors were significantly associated
with these 2 outcomes. The HRs for rehospitalization ranged from 0.80 (95% CI 0.75-0.85)
for old vs young age to 4.29 (95% CI 4.05-4.54) for many vs no prior admissions, whereas
the HRs for mortality ranged from 0.87 (95% CI 0.83-0.91) for any vs no practical
home care to 5.47 (95% CI 5.08-5.88) for old vs young age. Number of comorbidities,
medications, and prior contacts to the health care system were associated with higher
risk of both rehospitalization and mortality in a dose-response manner.
Conclusions and Implications
This study identified several potential factors of importance for short-term rehospitalization
and mortality in older patients discharged after pneumonia. This knowledge can help
physicians identify the patients with the highest need of care after admission for
pneumonia, thus enabling efficient discharge planning and high-quality provision of
care in primary care settings.
Keywords
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References
- Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011–2015.Eur J Clin Microbiol Infect Dis. 2019; 38: 553-561
- Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system.Respir Med. 2012; 106: 1778-1787
- Community-acquired pneumonia requiring hospitalization among U.S. Adults.N Engl J Med. 2015; 373: 415-427
- Pneumonia: Still the old man’s friend?.Arch Intern Med. 2003; 163: 317-323
- Iatrogenic complications in high-risk, elderly patients.Arch Intern Med. 1992; 152: 2074-2080
- Rethinking the patient: Using burden of treatment theory to understand the changing dynamics of illness.BMC Health Serv Res. 2014; 14: 281
- Rehospitalizations among patients in the Medicare Fee-for-Service Program.N Engl J Med. 2009; 360: 1418-1428
- Declining length of hospital stay for pneumonia and postdischarge outcomes.Am J Med. 2008; 121: 845-852
- A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia.Respirology. 2011; 16: 1119-1126
- Prediction of pneumonia 30-day readmissions: A single-center attempt to increase model performance.Respir Care. 2014; 59: 199-208
- Readmission following hospitalization for pneumonia: The impact of pneumonia type and its implication for hospitals.Clin Infect Dis. 2013; 57: 362-367
- Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia.Clin Infect Dis. 2008; 46: 550-556
- Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia.Chest. 2009; 136: 1079-1085
- Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons.Hum Vaccines Immunother. 2017; 13: 450-455
- The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia.J Hosp Med. 2010; 5: E12-E18
- Rising incidence and persistently high mortality of hospitalized pneumonia: A 10-year population-based study in Denmark.J Intern Med. 2006; 259: 410-417
- Predictors of rehospitalization after admission for pneumonia in the Veterans Affairs healthcare system.J Hosp Med. 2014; 9: 379-383
- Introduction to Danish (nationwide) registers on health and social issues: Structure, access, legislation, and archiving.Scand J Public Health. 2011; 39: 12-16
- The Danish Civil Registration System as a tool in epidemiology.Eur J Epidemiol. 2014; 29: 541-549
- IDA - En Integreret Database for Arbejdsmarkedsforskning [the Integrated Database for Longitudinal Labour Market Research].Denmark: Statistics Denmark, Copenhagen1991
- The Danish National Patient Register.Scand J Public Health. 2011; 39: 30-33
- The Danish National Health Service Register.Scand J Public Health. 2011; 39: 34-37
- The Danish Psychiatric Central Research Register.Scand J Public Health. 2011; 39: 54-57
- The Danish National Prescription Registry.Scand J Public Health. 2011; 39: 38-41
- The association between perceived stress and mortality among people with multimorbidity: A prospective population-based cohort study.Am J Epidemiol. 2016; 184: 199-210
- Prevalence of antibiotic use: A comparison across various European health care data sources.Pharmacoepidemiol Drug Saf. 2016; 25: 11-20
- Work stress and risk of death in men and women with and without cardiometabolic disease: A multicohort study.Lancet Diabetes Endocrinol. 2018; 6: 705-713
- Hyperkalaemia in people with diabetes: Occurrence, risk factors and outcomes in a Danish population-based cohort study.Diabet Med. 2018; 35: 1051-1060
- Risk of cervical cancer in women with autoimmune diseases, in relation with their use of immunosuppressants and screening: Population-based cohort study.Int J Cancer. 2015; 136: E711-E719
- Utilization of psychotropic drugs prescribed to persons with and without HIV infection: A Danish nationwide population-based cohort study.HIV Med. 2014; 15: 458-469
- Long-term risk of dementia among people with traumatic brain injury in Denmark: A population-based observational cohort study.Lancet Psychiatry. 2018; 5: 424-431
- Antidepressants and the risk of death in older patients with depression: A population-based cohort study.PLoS One. 2019; 14: e0215289
- Competing risks in epidemiology: Possibilities and pitfalls.Int J Epidemiol. 2012; 41: 861-870
- A note on robust variance estimation for cluster-correlated data.Biometrics. 2000; 56: 645-646
- Regression Modeling Strategies with Applications to Linear Models, Logistic Regression, and Survival Analysis.1st ed. Springer Science & Business Media, New York, NY2001
- Hospital readmissions of elderly patients hospitalized with pneumonia.Conn Med. 2003; 67: 599-603
- Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: A prospective cohort study.BMC Geriatr. 2010; 10: 22
- Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: A cross-sectional study in seven Spanish regions.BMJ Open. 2018; 8: e020243
- Sundhedsstyrelsen. Forebyggelse Af Uhensigtsmæssige Indlæggelser—En Oversigt over Viden Om Kommunale Indsatser [Prevention of Inappropriate Admissions—an Overview on Municipal Projects]. Copenhagen. 2015
- Impact of age and comorbidity on cause and outcome in community-acquired pneumonia.Chest. 2013; 144: 999-1007
- Factors associated with pneumonia outcomes: A nationwide population-based study over the 1997-2008 period.J Gen Intern Med. 2012; 27: 527-533
- Epidemiology and treatment outcome of pneumonia: Analysis based on Japan national database.J Infect Chemother. 2020; 26: 58-62
- Prediction of in-hospital death from community-acquired pneumonia by varying crb-age groups.Eur Respir J. 2013; 41: 917-922
- Assessment and control for confounding by indication in observational studies.J Am Geriatr Soc. 1999; 47: 749-754
- Short-term outcomes and their predictors for patients hospitalized with community-acquired pneumonia.Heart Lung. 2004; 33: 301-307
- The Danish health care system and epidemiological research: From health care contacts to database records.Clin Epidemiol. 2019; 11: 563-591
- Multidimensional prognostic index in association with future mortality and number of hospital days in a population-based sample of older adults: Results of the EU Funded MPI-AGE project.PLoS One. 2015; 10
- Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units.Age Ageing. 2008; 37: 416-422
Article info
Publication history
Published online: October 06, 2020
Footnotes
S.G. was funded by unrestricted grants from the General Practice Research Foundation of the Central Denmark Region (Region Midtjyllands Praksisforskningsfond), the Danish General Practice Fund (Fonden for Almen Praksis), Public Health in Central Denmark Region—a collaboration between municipalities and the region (Folkesundhed i Midten), the (Danish) Health Foundation (Helsefonden), and the Danish Foundation for Physicians (Lægefonden) under the A.P. Moeller Foundations. A.R.R. was funded by an unrestricted grant from the Novo Nordisk Foundation. The sponsors had no influence on the design of the study, the analysis of data, or the preparation of the manuscript.
The authors declare no conflicts of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
