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hospitalizations in elderly adults per 100000 population for the years 2007–2009 was 1208 for 65–74 years of age, 2398 for 75–84 years of age, and 4396 for ≥85 years of age. The annual incidence of hospitalizations in adults per 100000 population for the years 2014–2015 in Louisville calculated for the same age groups were 1699 for 65–74 years of age, 2452 for 75–84 years of age, and 4313 for ≥85 years of age. These 2 studies have remarkably similar incidence data for elderly adult hospitalizations in the United States. The NIS data included approximately 8 million annual hospitalizations and defined CAP using the International Classification of Diseases, Ninth Revision (ICD-9). We evaluated >186000 hospitalizations and defined CAP using clinical and radiographic criteria. These 2 studies suggest that ICD-9–based diagnosis for CAP, when used in a large number of patients, may approximate the diagnosis of CAP based on clinical and radiographic criteria. The second recent study evaluating hospitalizations in US adults was the Etiology of Pneumonia in Figure 2. The impact of age on the incidence of patients hospitalized with community-acquired pneumonia. Table 1. Characteristics of Unique Hospitalized Patients With Community-Acquired Pneumonia Enrolled in the University of Louisville Pneumonia Study Variable Value Demographics Age, y, median (IQR) 68 (24) Male sex 3443 (46.2) Black/African American race 1475 (19.8) Medical and social history Obese 2615 (35.1) HIV disease 110 (1.5) Neoplastic disease (active or within the last year) 990 (13.3) Renal disease 2185 (29.3) Chronic renal failure 604 (8.1) Congestive heart failure 2124 (28.5) Chronic obstructive pulmonary disease 3475 (46.7) Stroke 956 (12.8) Current smoker 2343 (31.5) Diabetes mellitus 2433 (32.7) Physical examination findings Temperature, °C, median (IQR) 37.2 (1.1) Respiratory rate, breaths/min, median (IQR) 22 (7) Systolic blood pressure, mm Hg, median (IQR) 116 (36) Diastolic blood pressure, mm Hg, median (IQR) 57 (19) Heart rate, beats/min, median (IQR) 105 (28) Laboratory findings Blood urea nitrogen, mg/dL, median (IQR) 19 (16) Serum glucose, mg/dL, median (IQR) 141 (81) Hematocrit, %, median (IQR) 35.7 (8.4) Serum sodium, mEq/L, median (IQR) 137 (6) Severity of disease ICU admission 1275 (17.1) Altered mental status on admission 1407 (18.9) Vasopressors on admission 213 (2.9) Ventilatory support on admission 987 (13.3) Pneumonia severity index, median (IQR) 101 (56) PSI risk class IV or V 4502 (60.4) Data are presented as No. (%) unless otherwise indicated. The impact of comorbid conditions on the incidence of patients hospitalized with community-acquired pneumonia. Abbreviations: CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease. Figure 4. The heatmap distribution of unique hospitalized patients with community-acquired pneumonia (CAP) in the city of Louisville (A), and the associations of CAP clustering with income level (B), black/African from https://academic.oup.com/cid/article/65/11/1806/4049508 by guest on 04 December 2021 Adults With Pneumonia: Incidence and Mortality • CID 2017:65 (1 December) • 1811 the Community (EPIC) study [5]. The authors found an annual incidence of hospitalizations due to CAP in the United States of 248 per 100000 adults; substantially lower than the NIS rates, as well as those in our study. As the primary objective of the EPIC study was to define the etiologic agents in patients with CAP, patients with risk factors for non-community-acquired respiratory pathogens were excluded. Applying the EPIC exclusion criteria available in the Louisville database, such as patients with immunosuppression, recent hospitalization, nursing home residents, and human immunodeficiency virus patients with CD4 count.
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