Pneumonia epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]

Overview

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in African Americans than caucasians. People who are hospitalized for any reason are also at high risk for pneumonia. Following urinary tract infections, pneumonia is the second most common cause of nosocomial infections, and its prevalence is 15-20% of the total number.

Epidemiology and Demographics

Table 1. Incidence of pneumococcal infections in the United States.
Age (years) Disease Incidence Cases/100,000 (number of cases) Death Rate Deaths/100,000 (number of deaths)
<1 31.4 (142) 0.22 (1)
1 24.6 (112) 0.22 (1)
2-4 12.6 (171) 0.15 (2)
5-17 2.2. (111) 0.02 (1)
18-34 3.7 (261) 0.26 (18)
35-49 10.3 (670) 0.65 (42)
50-64 19.5 (1,068) 1.86 (102)
≥ 65 37.0 (1,291) 5.61 (196)
Total 12.9 (3,828) 1.22 (363)
Adapted from CDC[3]

United States of America

  • It is the seventh most common cause of death in the United States
  • It causes around 500,000 hospitalizations and 65,000 deaths annually.

International

  • It is a common illness in all parts of the world.

Age

  • It is a major cause of death among all age groups.
  • In children, the majority of deaths occur in the newborn period, with over two million worldwide deaths a year.
  • In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia.[4]
  • Mortality decreases with age until late adulthood; elderly individuals are particularly at risk for CAP and associated mortality.

Seasonal

  • More common during winter months than during other times of the year.

Gender

  • CAP occurs more commonly in males than females

Race

  • More common in African Americans than caucasians.

Mortality

  • Patients hospitalized with pneumonia have a mortality rate of 12-14%.

Special Considerations

Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008. Obtained from CDC [1]

Countries with the highest estimated absolute number of new cases of clinical pneumonia in children
Country Predicted no. of new cases (millions) Estimated incidence(e/cy)
India 43.0 0.37
China 21.1 0.22
Pakistan 9.8 0.41
Bangladesh 6.4 0.41
Nigeria 6.1 0.34
Indonesia 6.0 0.28
Ethiopia 3.9 0.35
Democratic Republic of the Congo 3.9 0.39
Viet Nam 2.9 0.35
Philippines 2.7 0.27
Sudan 2.0 0.48
Afghanistan 2.0 0.45
United Republic of Tanzania 1.9 0.33
Myanmar 1.8 0.43
Brazil 1.8 0.11
Table adapted from WHO [2]

Estimates Of The Number Of New Episodes (Incidence) Of Community–Acquired Pneumonia In 2010 In Children 0–4 Years Of Age In 192 Countries

New episodes (incidence) New severe episodes (severe morbidity) Deaths (mortality)
Country WHO Region Population 0–4 years All ALRI SP Hib RSV FLU All ALRI SP Hib RSV FLU All ALRI SP Hib
AFRO REGION
Algeria AfroD 3446548 470713 34251 4697 135754 80351 53790 10297 783 7315 2251 2440 804 148
Angola AfroD 3377576 856794 62241 9674 247099 146255 97936 18712 1613 13293 4090 20429 6733 1398
Benin AfroD 1506408 424074 30705 5895 122303 72389 48501 9231 983 6558 2018 6281 2070 522
Burkina Faso AfroD 2955148 1047365 76085 11826 302060 178785 119719 22874 1972 16250 5000 17933 5911 1227
Cameroon AfroD 3054802 790160 56858 14815 227882 134880 90462 17094 2470 12143 3736 13341 4397 1463
Cape Verde AfroD 50634 9874 691 395 2848 1686 1136 208 66 148 45 39 13 8
Chad AfroD 2006165 678297 48155 19812 195621 115785 77827 14477 3304 10285 3164 14683 4840 2390
Comoros AfroD 122296 38380 2769 645 11069 6552 4392 832 108 591 182 377 124 37
Equ. Guinea AfroD 107207 16341 1144 654 4713 2789 1879 344 109 244 75 402 132 85
Gabon AfroD 185179 36186 2579 943 10436 6177 4149 775 157 551 170 291 96 43
Gambia AfroD 287078 79805 2667 802 23016 13623 8746 802 134 1338 412 987 171 56
Ghana AfroD 3532887 795448 57857 8199 229407 135783 90905 17394 1367 12357 3802 7808 2573 490
Guinea AfroD 1657883 546525 39262 10948 157618 93292 62586 11804 1826 8385 2580 7689 2534 895
Guin.–Bissau AfroD 240350 75199 5429 1216 21687 12836 8605 1632 203 1159 357 1592 525 152
Liberia AfroD 680701 212990 15195 5418 61426 36357 24419 4568 903 3245 999 1611 531 232
Madagascar AfroD 3305278 1051407 76189 13932 303226 179475 120231 22906 2323 16272 5007 8004 2638 637
Mali AfroD 2911668 932894 67350 15086 269047 159245 106745 20248 2516 14384 4426 23947 7893 2292
Mauritania AfroD 513267 144982 10415 2904 41813 24748 16603 3131 484 2224 684 2099 692 244
Mauritius AfroD 84433 13518 985 117 3899 2307 1544 296 20 210 65 20 7 1
Niger AfroD 3084517 1127652 81210 20418 325215 192490 129082 24415 3405 17344 5337 19004 6264 2018
Nigeria AfroD 26568927 7339761 513783 293590 2116787 1252897 844072 154465 48956 109729 33763 121201 39948 25767
S. Tome & P'e AfroD 23490 5118 373 46 1476 874 585 112 8 80 25 79 26 4
Senegal AfroD 2081483 591373 42853 7836 170552 100947 67625 12883 1307 9152 2816 4612 1520 367
Seychelles AfroD 5623 862 63 7 248 147 98 19 1 13 4 2 1 0
Sierra Leone AfroD 969597 315676 22866 4286 91041 53886 36101 6874 715 4883 1503 7262 2393 591
Togo AfroD 862745 280487 20292 4082 80893 47879 32083 6101 681 4334 1333 3321 1095 288
Zimbabwe AfroD 1692247 349031 25271 4852 100661 59580 39918 7598 809 5397 1661 2461 811 205
Botswana AfroE 225120 47818 3347 1913 13791 8162 5499 1006 319 715 220 159 52 34
Burundi AfroE 1184632 349477 25440 3373 100789 59656 39933 7648 562 5433 1672 7259 2393 428
Cen. Afr. Rep. AfroE 651222 195417 13981 4538 56358 33358 22394 4203 757 2986 919 3911 1289 520
Congo AfroE 623244 168619 12244 1959 48630 28783 19275 3681 327 2615 805 2001 659 141
Cote d'Ivoire AfroE 2969425 985611 71421 13060 284250 168244 112707 21472 2178 15253 4693 11003 3626 875
D. Rep. Congo AfroE 11848026 3671614 263117 80589 1058894 626745 420631 79104 13438 56194 17291 86897 28641 10986
Eritrea AfroE 861496 208035 15163 1802 59997 35512 23766 4559 301 3238 996 2419 797 129
Ethiopia AfroE 11931668 3367561 240540 82471 971205 574843 386005 72317 13752 51372 15807 37269 12284 5196
Kenya AfroE 6664323 1645189 119118 22871 474473 280834 188157 35812 3814 25440 7828 17064 5624 1419
Lesotho AfroE 274307 58335 4224 811 16824 9958 6672 1270 135 902 278 607 200 50
Malawi AfroE 2714859 658512 47877 7004 189915 112408 75261 14394 1168 10225 3146 6932 2285 448
Mozambique AfroE 3876419 1155781 83373 19438 333327 197292 132266 25065 3241 17806 5479 13167 4340 1307
Namibia AfroE 286374 63796 4619 887 18399 10890 7296 1389 148 987 304 287 95 24
Rwanda AfroE 1830654 397910 13638 3991 114757 67923 43646 4100 666 6659 2049 4145 734 236
South Africa AfroE 5041132 705554 33436 14342 203482 120438 78749 10052 2392 11357 3494 5156 1218 583
Swaziland AfroE 156715 28802 2091 344 8306 4916 3293 629 57 446 137 471 155 34
Uganda AfroE 6465275 1745727 126241 25969 503468 297996 199697 37953 4330 26961 8296 21181 6981 1876
U. R. Tanzania AfroE 8009544 2151379 156285 24291 620458 367240 245913 46986 4051 33378 10270 17467 5757 1195
Zambia AfroE 2412190 576056 41709 8008 166135 98333 65882 12539 1335 8908 2741 6141 2024 511
AMRO REGION
Canada AmroA 1884546 25275 866 271 13709 8032 6438 604 105 3774 755 27 5 2
Cuba AmroA 569056 8208 598 79 4452 2609 2178 417 31 1140 228 63 21 4
USA AmroA 21650217 313322 22733 3845 169946 99574 83169 15868 1489 43355 8671 799 263 59
Antigua & B'a AmroB 7756 686 50 6 198 117 78 15 1 41 8 0 0 0
Argentina AmroB 3385831 311588 22663 3212 89862 53188 35609 6814 536 18616 3723 952 314 60
Bahamas AmroB 25507 2514 182 23 725 429 287 55 4 151 30 25 8 1
Barbados AmroB 14562 1377 60 19 397 235 153 18 3 87 17 4 1 0
Belize AmroB 36599 4795 349 46 1383 819 548 105 8 287 57 9 3 1
Brazil AmroB 15156449 1497706 95518 14711 431938 255658 169535 28717 2453 91150 18230 3079 916 181
Chile AmroB 1219437 88722 6448 973 25588 15145 10141 1938 162 5296 1059 145 48 10
Colombia AmroB 4497661 488486 31421 6092 140879 83385 55372 9446 1016 29585 5917 1530 459 113
Costa Rica AmroB 362979 37185 1272 425 10724 6348 4080 382 71 2389 478 24 4 2
Dominica AmroB 5924 703 51 6 203 120 80 15 1 42 8 0 0 0



Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia (DO NOT EDIT) [3]

  • Many patients with HAP, VAP, and HCAP are at increased risk for colonization and infection with MDR pathogens (Level II)
  • It is often difficult to define the exact incidence of HAP and VAP, because there may be an overlap with other lower respiratory tract infections, such as tracheobronchitis, especially in mechanically ventilated patients (Level III).
  • The exact incidence of HAP is usually between 5 and 15 cases per 1,000 hospital admissions depending on the case definition and study population; the exact incidence of VAP is 6- to 20-fold greater than in nonventilated patients (Level II).
  • HAP and VAP are a frequent cause of nosocomial infection that is associated with a higher crude mortality than other hospital-acquired infections (Level II).
  • Patients with late-onset HAP and VAP are more likely to be infected with MDR pathogens and have higher crude mortality than patients with early-onset disease; patients with early-onset HAP who have recently received antibiotics or had an admission to a healthcare facility are at risk for colonization and infection with MDR pathogens (Level II).
  • An increase in crude and attributable mortality for HAP and VAP is associated with the presence of MDR pathogens (Level II).
  • Bacteria cause most cases of HAP, VAP, and HCAP and many infections are polymicrobial; rates are especially high in patients with ARDS (Level I).
  • HAP, VAP, and HCAP are commonly caused by aerobic gram-negative bacilli, such as P. aeruginosa, K. pneumoniae, and Acinetobacter species, or by gram-positive cocci, such as S. aureus, much of which is MRSA; anaerobes are an uncommon cause of VAP (Level II).
  • Rates of L. pneumophila vary considerably between hospitals and disease occurs more commonly with serogroup 1 when the water supply is colonized or there is ongoing construction (Level II).
  • Nosocomial virus and fungal infections are uncommon causes of HAP and VAP in immunocompetent patients. Outbreaks of influenza have occurred sporadically and risk of infection can be substantially reduced with widespread effective infection control, vaccination, and use of antiinfluenza agents (Level I).
  • The prevalence of MDR pathogens varies by patient population, hospital, and type of ICU, which underscores the need for local surveillance data (Level II).
  • MDR pathogens are more commonly isolated from patients with severe, chronic underlying disease, those with risk factors for HCAP, and patients with late-onset HAP or VAP (Level II)

For Level of evidence and classes click here.

References

  1. "Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases".
  2. http://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html
  3. "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Retrieved 2012-09-13. Unknown parameter |month= ignored (help)

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