Increasing hospital admissions for pneumonia in England

Background. The burden of community-acquired pneumonia (CAP) in the UK is high, particularly among elderly adults. Streptococcus pneumoniae is a leading cause of CAP. The recent introduction of pneumococcal conjugate vaccines (PCV) into the UK immunisation schedule may influence the epidemiology of pneumonia by reducing transmission of S. pneumoniae. Trends in hospital admissions for pneumonia in England were examined between April 1997 and March 2005, to establish a pre-PCV baseline. Methods. Data were extracted from Hospital Episode Statistics (HES) if pneumonia-specific ICD-10 codes J12-J18 were identified in any diagnostic field. Deaths that occurred in-hospital within 30 days of admission were identified and co-morbidities were defined using an index. Only the first episode per individual per year was retained for analysis. Results. The age-standardised incidence of hospitalisation with a primary diagnosis of pneumonia increased by 34% from 1.48 to 1.98 per 1000 population between 1997/98 and 2004/05. The increase was more marked in older adults, in whom mortality was highest, The proportion of patients with recorded co-morbidities also rose. Discussion. Similar trends in pneumonia hospitalisations have been observed in other countries. The rise in pneumonia hospitalisations in England may be attributable to population factors, changes in HES coding, changes to health service organisation, other biological phenomenon, or a combination of these effects. In contrast, pneumonia incidence has decreased in primary care.