Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

Catherine Hyams; Elizabeth Begier; Maria Garcia Gonzalez; Jo Southern; James Campling; Sharon Gray; Jennifer L Oliver; Bradford Gessner; Adam Finn

doi:10.1136/bmjopen-2021-057464

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

Catherine Hyams^*, Elizabeth Begier, Maria Garcia Gonzalez, Jo Southern, James Campling, Sharon Gray, Jennifer L Oliver, Bradford Gessner, Adam Finn

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

10 Citations (Scopus)

55 Downloads (Pure)

Abstract

Objectives
To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.

Setting
Single-centre, secondary care hospital, Bristol, UK.

Design
We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice’s denominator contribution calculated based on practice population and per cent of the practices’ hospitalisations admitted to the study hospital.

Participants
Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions.

Primary and secondary outcome measures
The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK.

Results
Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65–74 (3684 per 100 000 adults), 75–84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results.

Conclusions
The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection

Original language	English
Article number	e058857
Number of pages	15
Journal	BMJ Open
Volume	12
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2021-057464
Publication status	Published - 15 Jun 2022

Bibliographical note

Funding Information:
Funding CH was funded by the National Institute for Health Research (NIHR) (NIHR Academic Clinical Fellowship (ACF-2015-25-002)). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The remainder of the study funding was from Pfizer (WI255886-1).

Funding Information:
Competing interests EB, JS, JC, SG and BDG are full-time employees of Pfizer Vaccines and hold stock or stock options. CH is the Principal Investigator of the Avon CAP study (ISRCTN:17354061) which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and chair of the WHO European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Keywords

Pneumonia
respiratory infection
lower respiratory tract infection
heart failure

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bmjopen-2021-057464

Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMJ at |http://dx.doi.org/10.1136/bmjopen-2021-057464 . Please refer to any applicable terms of use of the publisher.
Final published version, 938 KBLicence: CC BY

Handle.net

Persistent link

Cite this

Hyams, C., Begier, E., Garcia Gonzalez, M., Southern, J., Campling, J., Gray, S., Oliver, J. L., Gessner, B., & Finn, A. (2022). Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology. BMJ Open, 12(6), Article e058857. https://doi.org/10.1136/bmjopen-2021-057464

@article{dffccef85de443fe9fd58180ed8f4ea9,

title = "Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology",

abstract = "Objectives To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.Setting Single-centre, secondary care hospital, Bristol, UK.Design We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice{\textquoteright}s denominator contribution calculated based on practice population and per cent of the practices{\textquoteright} hospitalisations admitted to the study hospital.Participants Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions.Primary and secondary outcome measures The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK.Results Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65–74 (3684 per 100 000 adults), 75–84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results.Conclusions The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection",

keywords = "Pneumonia, respiratory infection, lower respiratory tract infection, heart failure",

author = "Catherine Hyams and Elizabeth Begier and {Garcia Gonzalez}, Maria and Jo Southern and James Campling and Sharon Gray and Oliver, {Jennifer L} and Bradford Gessner and Adam Finn",

note = "Funding Information: Funding CH was funded by the National Institute for Health Research (NIHR) (NIHR Academic Clinical Fellowship (ACF-2015-25-002)). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The remainder of the study funding was from Pfizer (WI255886-1). Funding Information: Competing interests EB, JS, JC, SG and BDG are full-time employees of Pfizer Vaccines and hold stock or stock options. CH is the Principal Investigator of the Avon CAP study (ISRCTN:17354061) which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and chair of the WHO European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.",

year = "2022",

month = jun,

day = "15",

doi = "10.1136/bmjopen-2021-057464",

language = "English",

volume = "12",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

}

Hyams, C, Begier, E, Garcia Gonzalez, M, Southern, J, Campling, J, Gray, S, Oliver, JL, Gessner, B & Finn, A 2022, 'Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology', BMJ Open, vol. 12, no. 6, e058857. https://doi.org/10.1136/bmjopen-2021-057464

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology. / Hyams, Catherine; Begier, Elizabeth; Garcia Gonzalez, Maria et al.
In: BMJ Open, Vol. 12, No. 6, e058857, 15.06.2022.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

AU - Hyams, Catherine

AU - Begier, Elizabeth

AU - Garcia Gonzalez, Maria

AU - Southern, Jo

AU - Campling, James

AU - Gray, Sharon

AU - Oliver, Jennifer L

AU - Gessner, Bradford

AU - Finn, Adam

N1 - Funding Information: Funding CH was funded by the National Institute for Health Research (NIHR) (NIHR Academic Clinical Fellowship (ACF-2015-25-002)). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The remainder of the study funding was from Pfizer (WI255886-1). Funding Information: Competing interests EB, JS, JC, SG and BDG are full-time employees of Pfizer Vaccines and hold stock or stock options. CH is the Principal Investigator of the Avon CAP study (ISRCTN:17354061) which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and chair of the WHO European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

PY - 2022/6/15

Y1 - 2022/6/15

N2 - Objectives To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.Setting Single-centre, secondary care hospital, Bristol, UK.Design We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice’s denominator contribution calculated based on practice population and per cent of the practices’ hospitalisations admitted to the study hospital.Participants Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions.Primary and secondary outcome measures The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK.Results Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65–74 (3684 per 100 000 adults), 75–84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results.Conclusions The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection

AB - Objectives To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.Setting Single-centre, secondary care hospital, Bristol, UK.Design We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice’s denominator contribution calculated based on practice population and per cent of the practices’ hospitalisations admitted to the study hospital.Participants Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions.Primary and secondary outcome measures The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK.Results Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65–74 (3684 per 100 000 adults), 75–84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results.Conclusions The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection

KW - Pneumonia

KW - respiratory infection

KW - lower respiratory tract infection

KW - heart failure

UR - https://bmjopen.bmj.com/content/12/6/e057464

U2 - 10.1136/bmjopen-2021-057464

DO - 10.1136/bmjopen-2021-057464

M3 - Article (Academic Journal)

C2 - 35705333

SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e058857

ER -

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Handle.net

Other files and links

Fingerprint

The AvonCAP Study

Cite this

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Handle.net

Other files and links

Fingerprint

Projects

The AvonCAP Study

Cite this