Socioeconomic Position and the Incidence, Severity, and Clinical Outcomes of Hospitalized Patients With Community-Acquired Pneumonia.

Autor:	Wiemken TL; 7547 Center for Health Outcomes Research, Saint Louis University, St. Louis, MO, USA., Carrico RM; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA., Furmanek SP; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA., Guinn BE; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA., Mattingly WA; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA., Peyrani P; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA., Ramirez JA; 5170 Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Jazyk:	angličtina
Zdroj:	Public health reports (Washington, D.C. : 1974) [Public Health Rep] 2020 May/Jun; Vol. 135 (3), pp. 364-371. Date of Electronic Publication: 2020 Mar 31.
DOI:	10.1177/0033354920912717
Abstrakt:	Objectives: The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). Methods: This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group-level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. Results: The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) ( P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. Conclusions: Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.
Databáze:	MEDLINE
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