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 journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
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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.

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

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.

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.

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.

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 languageEnglish
Article numbere058857
Number of pages15
JournalBMJ Open
Issue number6
Publication statusPublished - 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.


  • Pneumonia
  • respiratory infection
  • lower respiratory tract infection
  • heart failure


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