Abstract
Background
Community-Acquired Pneumonia (CAP) is regarded as a substantial part of the global burden of disease and a public health priority. Besides host factors, such as sociodemographic characteristics, comorbidities and clinical severity, CAP morbidity and mortality may also be related to other factors like socioeconomic background, seasonality and level of health care. This study aims to analyze trends in hospital admissions and in-hospital mortality due to CAP in National Health Service hospitals in mainland Portugal from 2010 to 2018. Additionally, it seeks to assess the impact of various host and external factors on in-hospital mortality attributed to CAP.
Methods
A retrospective cross-sectional study was conducted on 391,732 CAP hospitalizations. Multivariable Logistic Regression analysis was used to estimate the probability of in-hospital death, considering various host and environmental factors.
Results
A decrease in the number of admissions and mortality rate over time was observed. The regression model identified advanced age, male gender, clinical severity, comorbidities, summer season, early school leaving rate, unemployment rate, and lower hospital differentiation as factors increasing the probability of death (p < 0.001).
Conclusions
Throughout the nine-year span, a consistent decline in in-hospital mortality rates was observed. Mortality exhibited a dual influence, being shaped by host factors (such as age, sex, clinical severity, and comorbidities) as well as non-traditional factors, such as socioeconomic vulnerability, the summer season, and the level of hospital differentiation. Therefore, effectively reducing CAP mortality necessitates comprehensive policies that target at-risk groups and address a broad range of risk factors. These policies should prioritize enhancing vaccination coverage, improving healthcare accessibility, and ameliorating thermal housing conditions, especially for socially vulnerable individuals.