The hospitalization burden of all-cause pneumonia in China: A population-based study, 2009–2017

Background Pneumonia represents a public health problem of substantial health and economic burden. However, the evidence on the burden of adult pneumonia is limited in China. Methods The China Kadoorie Biobank recruited 512,725 participants aged 30-79 years from five urban and five rural areas during 2004-2008. The current analyses included 506,086 participants who were alive in 2009. Pneumonia hospitalizations were ascertained through the health insurance system until December 31, 2017. Generalized linear models were used to examine the secular trends and regional and population variations in pneumonia hospitalization rate, mean length of hospital stay (LOS), and 30-day case fatality rate (CFR). Findings A total of 27,879 participants with 36,567 pneumonia hospitalizations were identified with a mean followup time of 8.9 years. The unadjusted hospitalization rate was 8.4 (95% confidence interval [CI]: 8.3, 8.6) per 1000 person-years, with an increase of 15.5% annually from 4.2 (3.9, 4.4) in 2009 to 10.9 (10.6, 11.3) in 2017, after adjusting for age, sex, study area. The mean LOS was 8.8 (95% CI: 8.7, 8.9) days, with a slight decrease of 1.0% annually from 2009 to 2017. The average 30-day CFR remained practically unchanged at 2. 4 (95% CI: 2. 2, 2. 5) deaths per 100 admissions. A clear seasonal pattern of pneumonia hospitalization rate was observed, and the hospitalization rate and CFR differed across regions and subpopulations of different ages and underlying conditions. Interpretation There was an increasing hospitalization burden of pneumonia in Chinese adults, especially for adults aged >= 60 years or those with underlying conditions. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.