BACKGROUND: The elderly ≥ 65 years have been identified to be at higher risk for Community-Acquired Pneumonia (CAP) with higher associated morbidity and mortality. While the clinical and economic burden of CAP in this population has been extensively studied, the burden of illness has not been compared to other serious diseases.

OBJECTIVES: To estimate the mean length of hospital stay, in-hospital mortality, and charges/cost associated with CAP compared with myocardial infarction(MI), stroke and diabetes mellitus (DM) in hospitalized elderly patients.

METHODS: A retrospective analysis was conducted using the 2014 National Readmission Database. Individuals ≥ 65 years hospitalized for any of the four conditions were included in the study. Comparisons were made using chi-square and Kruskal Wallis tests. Generalized linear models was used to estimate relative risks while controlling for confounders.

RESULTS: 2,683,665 hospitalizations representing 5,883,684 hospitalizations were analyzed. The mean age of the population was 77.1(± 7.8) years with a majority (91%) on Medicare coverage. In-hospital mortality was 1.8%, 2.0%, 1.1% and 0.4% for CAP, diabetes, MI and stroke respectively (p-value <0.0001). Adjusting for co-variates, odds of in-hospital mortality was lower in diabetes (OR: 0.36, 95%CI: 0.36-0.37) and MI (OR: 0.67, 95%CI: 0.65-0.69) compared to CAP. Median length of CAP-related hospital-stay was 5 days – which is higher compared to stroke patients (RR: 1.13, 95% CI, 1.12-1.13), but lower compared to diabetics (RR: 0.84, 95% CI, 0.83-0.84, p-value <0.001) and MI cases (RR: 0.81, 95% CI, 0.81-0.82). Median charge associated with CAP was $36,000- which is lower in CAP-cases compared to diabetes (RR: 0.87, 95% CI, 0.87-0.87), but higher compared to stroke (RR: 1.15, 95% CI, 1.15-1.15) and higher compared to MI cases. (RR: 1.01, 95% CI, 1.01-1.01).

CONCLUSIONS: CAP is associated with significant clinical and economic burden and comparable to serious conditions like MI, stroke and diabetes mellitus.