Clinical Outcomes and Economic Burden of Acute Lower Respiratory Tract Infection-Related Hospitalizations Among Adults in the United States Post COVID-19 Pandemic
Author(s)
Ning A. Rosenthal, MPH, PhD, MD, Chendi Cui, MS, PhD, Rena C. Moon, MPH, MD, Joy David, BS, Isabel Gomez, MS, Rheana D. Lipscomb, MPH, Laura A. Curry, MS, PhD, Julie A. Gayle, MPH, Claire Evans, BS, Leslie A. Carabuena, MS, Rachel H. Mackey, MPH, PhD.
Premier Inc., Charlotte, NC, USA.
Premier Inc., Charlotte, NC, USA.
OBJECTIVES: To assess post-pandemic clinical and healthcare resource use (HRU) burden of lower respiratory tract infection (LRTI)-related hospitalizations in the United States (U.S.).
METHODS: In a retrospective observational study using the Premier Healthcare Database (includes 25% of U.S. hospitalizations), we analyzed adult (age≥18 years) hospitalizations during 2022-2024 with 1) primary diagnosis of LRTI or 2) secondary diagnosis of LRTI with primary diagnosis of blood stream infection, without diagnosis of fungal or mycobacterial pulmonary disease. LRTIs were classified as mutually exclusive categories of influenza, respiratory syncytial virus (RSV), COVID-19 (SARS-CoV-2), other-viral, bacterial, multiple-pathogen, and other/unknown pathogen infections. Descriptive statistics were used to compare patient characteristics, clinical outcomes, and costs adjusted to 2024 U.S. dollars using consumer price index for hospital services. National hospitalization and cost estimates were calculated using projection weights.
RESULTS: We analyzed 2,437,746 LRTI-related hospitalizations (Influenza: 119,545; COVID-19: 704,540; RSV: 23,237; Other viral: 56,098; Bacterial: 309,220; Multiple-pathogen: 123,182; other/unknown pathogen: 1,101,924). Patient characteristics were: mean age of 68 years, 51% female, 75% White. Top comorbidities were: chronic pulmonary disease (49%), renal disease (47%), diabetes (39%), and congestive heart failure (38%). Compared to influenza, patients with other LRTIs were older (mean 66.3-70.6 vs. 64.3 years), had higher in-hospital mortality (3.2-13.5% vs 2.7%) and ICU admission (15.1-33% vs. 14.6%), longer length of hospital stay (6-11 vs. 5 days), higher hospitalization cost ($16,116-30,327 vs. $13,269) and 30-day readmission (11-15% vs. 9%), with the worst outcomes in bacterial or multiple-pathogen infections. Total estimated U.S. LRTI-related hospitalizations during 2022-2024 were 10,465,379, with total hospitalization cost exceeding $201 billion, and COVID-19, bacterial, and other/unknown LRTI accounting for 26%, 17%, and 43% of cost, respectively.
CONCLUSIONS: Post-pandemic LRTI-related hospitalizations have severe clinical outcomes, high HRU and costs. Increasing utilization of effective prevention measures (e.g., vaccination) among at-risk populations may help mitigate the burden of LRTIs.
METHODS: In a retrospective observational study using the Premier Healthcare Database (includes 25% of U.S. hospitalizations), we analyzed adult (age≥18 years) hospitalizations during 2022-2024 with 1) primary diagnosis of LRTI or 2) secondary diagnosis of LRTI with primary diagnosis of blood stream infection, without diagnosis of fungal or mycobacterial pulmonary disease. LRTIs were classified as mutually exclusive categories of influenza, respiratory syncytial virus (RSV), COVID-19 (SARS-CoV-2), other-viral, bacterial, multiple-pathogen, and other/unknown pathogen infections. Descriptive statistics were used to compare patient characteristics, clinical outcomes, and costs adjusted to 2024 U.S. dollars using consumer price index for hospital services. National hospitalization and cost estimates were calculated using projection weights.
RESULTS: We analyzed 2,437,746 LRTI-related hospitalizations (Influenza: 119,545; COVID-19: 704,540; RSV: 23,237; Other viral: 56,098; Bacterial: 309,220; Multiple-pathogen: 123,182; other/unknown pathogen: 1,101,924). Patient characteristics were: mean age of 68 years, 51% female, 75% White. Top comorbidities were: chronic pulmonary disease (49%), renal disease (47%), diabetes (39%), and congestive heart failure (38%). Compared to influenza, patients with other LRTIs were older (mean 66.3-70.6 vs. 64.3 years), had higher in-hospital mortality (3.2-13.5% vs 2.7%) and ICU admission (15.1-33% vs. 14.6%), longer length of hospital stay (6-11 vs. 5 days), higher hospitalization cost ($16,116-30,327 vs. $13,269) and 30-day readmission (11-15% vs. 9%), with the worst outcomes in bacterial or multiple-pathogen infections. Total estimated U.S. LRTI-related hospitalizations during 2022-2024 were 10,465,379, with total hospitalization cost exceeding $201 billion, and COVID-19, bacterial, and other/unknown LRTI accounting for 26%, 17%, and 43% of cost, respectively.
CONCLUSIONS: Post-pandemic LRTI-related hospitalizations have severe clinical outcomes, high HRU and costs. Increasing utilization of effective prevention measures (e.g., vaccination) among at-risk populations may help mitigate the burden of LRTIs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD34
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Disease
Infectious Disease (non-vaccine), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)