An epidemiological study coordinated by IDOR analyzes the number of hospitalizations and the mortality rate of the disease over 10 years

Presented at this year’s Brazilian Intensive Care Medicine Congress, a new study examined a decade of hospital data from the public health system to build an epidemiological history of hospitalizations for community-acquired pneumonia (CAP). The research, coordinated by the D’Or Institute for Research and Education (IDOR) in collaboration with the Pontifical Catholic University of Rio de Janeiro (PUC-RIO), Oswaldo Cruz Foundation (Fiocruz), and Federal University of Rio de Janeiro (UFRJ), brought important findings to understand the evolution of CAP in Brazil and its implications for public health. 

Community-Acquired Pneumonia 

Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and intensive care unit (ICU) admissions worldwide. In contrast to hospital-acquired pneumonia, which affects patients already hospitalized and is acquired within healthcare facilities, CAP is contracted in everyday settings, whether at work or at individuals’ homes. 

Although the disease does not always require the hospitalization of patients, the Ministry of Health (Brazil) estimates that CAP and influenza together result in over 600,000 annual hospitalizations in the Brazilian Unified Health System (SUS). Despite these estimates, the real incidence of CAP is much more challenging to measure, because epidemiological studies have limitations and heterogeneity in both case selection and methodologies used. 

CAP in Brazil 

Considering that a more detailed epidemiological history would be very relevant to guide more effective prevention and treatment measures for CAP, the current study aimed to analyze the epidemiology and clinical outcomes of patients with CAP hospitalized in Brazilian public hospitals over a decade, from 2011 to 2021. 

To conduct the research, the authors performed a retrospective analysis of CAP hospitalizations in the Brazilian Unified Health System (SUS) between 2011 and 2021. The data were primarily collected from DATASUS and included demographic information, causes of hospitalization, and clinical outcomes of CAP patients, considering the hospital mortality rate and length of ICU stay. The study included only adult patients, totaling 3.3 million hospitalizations in the selected period. 

One of the research leaders, Dr. Rodolfo Espinoza, a Ph.D. student at IDOR and a physician at Rede D’Or and at the National Cancer Institute, commented that pneumonia puts a burden on the healthcare system, with about 10% of hospitalized elderly patients experiencing the problem. However, there is not enough information for the implementation of more effective containment measures in Brazilian ICUs, prompting the researcher and his team to gather this data in the public system. “To identify cases in the public health system, we had access to microdata from 170 million hospitalizations in SUS over this ten-year period, so we filtered this information according to codes compatible with pneumonia,” he explained. 

The initial results indicated that between 2011 and 2019, there was a modest reduction in the rate of ICU admissions for CAP in the public system. However, during the same period, the number of deaths in the hospital environment increased by 31.5%. 

Taking a closer look at the pattern of the hospital mortality rate growth, the researchers identified that the lethality for patients admitted to ICUs decreased by 12% from 2011 to 2019, while the number of deaths outside the ICU increased during the same interval, rising by 27.4%. 

Considering the peak period of the COVID-19 pandemic, the years 2020 and 2021 showed a reduction in CAP hospitalizations compared to 2019. This may have occurred due to the social isolation measures adopted during the pandemic, which not only slowed the spread of COVID-19 but also contained the spread of other infectious diseases. 

However, this reduction in CAP hospitalizations during the pandemic did not reflect in other analyzed rates: between 2019 and 2021, there was an increased occupancy of ICUs by CAP (6.1% in 2019 and 9.8% in 2021), and there was also an increase in the lethality of CAP patients hospitalized outside the ICU (6.54% in 2019 and 8.16% in 2021). 

An Emerging Problem 

The study results indicate that CAP continues to be a significant cause of hospitalizations in hospitals and ICUs. Despite a reduction in the total number of hospitalizations, the research showed that overall mortality is increasing for hospitalized patients. 

The data highlighted by the current study point to the need for a better understanding of the trajectory of CAP patients within the healthcare system. The authors emphasize that this data is essential to choose effective interventions in reducing the number of hospitalizations and hospital mortality. 

Notes 

Before the Brazilian Congress, the study was first presented in October at an international event organized by the European Society of Intensive Care Medicine (ESICM).  

Written by Maria Eduarda Ledo de Abreu.