Study Compares Disease Burden of Hospital-Acquired vs. Community-Acquired Pneumonia In Malaysia, Indonesia, Philippines

Study Compares Disease Burden of Hospital-Acquired vs. Community-Acquired Pneumonia In Malaysia, Indonesia, Philippines

The disease burden of pneumonia in three Southeast Asian countries was recently evaluated in a study titled “Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines,” which was published in the International Journal of Infectious Diseases.

Pneumonia, characterized by inflammation of the microscopic air sacs of lungs, resulted in approximately 120 million respiratory episodes worldwide as of 2010. The disease is identified as the leading cause of death, particularly among children, and the most common reason for admission to hospitals.

Depending on the patient’s location prior to exposure, pneumonia can be categorized as hospital-acquired pneumonia (HAP) or community-acquired pneumonia (CAP). HAP and CAP differ in many aspects, including the causal pathogens and bacteria, the occurrence of symptoms, and rates of morbidity and mortality in patients.

“Being able to differentiate between CAP and HAP is of interest to clinicians and researchers. Few studies have compared the incidence of both pneumonia types. One such study was conducted in Italy’s Lazio region exploring the incidence of CAP, HAP or Acquired Immunodeficiency Syndrome (AIDS)-related pneumonia using hospital information system data,” the authors wrote.

Few studies on pneumonia incidence have been reported in Asian countries. Of those that have been published, most investigated disease causes, antibiotic resistance, and risk factors.

In this study, researchers examined the incidence frequency, mortality, cost, and length of stay (LOS) between CAP and HAP hospitalized patients in Malaysia, Indonesia, and the Philippines, using data from the Casemix system from hospitals of these countries.

Patients with pneumonia were identified by ICD-10 codes, based on various pathogens and bacteria-causing inflammation, and separated into CAP and HAP cases using a logical algorithm. Afterwards, parameters related to incidence of hospitalization, case fatality rates (CFR), mean length of stay (LOS), and cost of admission were estimated. For population incidence, only data from Malaysia was utilized for calculations.

The results suggested that pneumonia incident rates were higher in younger and elderly patients. The estimates indicated that per 100,000 discharges, there were 14,245 CAP and 5,615 HAP cases in the Philippines; 4,205 CAP and 2,187 HAP cases in Malaysia; and 988 CAP and 538 HAP cases in Indonesia.

Most of the parameters were found higher for HPA when compared to CAP:  CFR (9.1-25.5 percent for HAP versus 1.4-4.2 percent for CAP), mean LOS (6.9-10.2 days for HAP versus 6.1-8.6 days for CAP), and cost of hospitalization (USD 275-1,482 for HAP vs. USD 254-1,208 for CAP).

“The burden of CAP and HAP is high. Results varied between the three countries likely due to differences in socio-economic conditions, health system differences, and ICD-coding practices,” the researchers concluded.

“Meanwhile, other data owners, such as social insurance providers or medical providers, should be encouraged to share data with researchers for the purpose of increasing knowledge of disease epidemiology in their respective countries. A better understanding of the burden of pneumonia and other diseases in Southeast Asia can help to plan preventive strategies and improve clinical management,” they added.

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