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

• Published in: Public health reports (1974) Vol. 135; no. 3; pp. 364 - 371
• Main Authors: Wiemken, Timothy L., Carrico, Ruth M., Furmanek, Stephen P., Guinn, Brian E., Mattingly, William A., Peyrani, Paula, Ramirez, Julio A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Sage Publications, Inc 01.05.2020; SAGE Publications; SAGE PUBLICATIONS, INC
• Subjects: Adolescent; Adult; Adults; Aged; Aged, 80 and over; Clinical outcomes; Community-Acquired Infections; Confidence intervals; Deprivation; Evaluation; Female; Health Status Disparities; Hospitalization; Humans; Incidence; Kentucky - epidemiology; Male; Middle Aged; Mortality; Patients; Pneumonia; Pneumonia - epidemiology; Pneumonia - mortality; Prospective Studies; Retrospective Studies; Risk Factors; Severity of Illness Index; Socio-economic aspects; Socioeconomic Factors; Socioeconomics; Young Adult; Kentucky; disparities; severity; inequalities; social inequalities; long-term mortality; 1-year mortality; late outcomes; incidence
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/0033354920912717

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.