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Results of a Population-Based Active Surveillance Study in Ohio

Barbara J. Marston, MD; Joseph F. Plouffe, MD; Thomas M. File, Jr, MD; Barbara A. Hackman, MS, MPH; Sara-Jane Salstrom; Harvey B. Lipman, PhD; Margarette S. Kolczak, PhD; Robert F. Breiman, MD

Arch Intern Med. 1997;157(15):1709-1718.

Abstract
Background
Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined.

Methods
We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia. Information about risk factors, symptoms, and outcome was collected through interview and medical chart review. Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests.

Results
The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100 000 population; the overall case-fatality rate was 8.8%. Pneumonia incidence was higher among blacks than whites (337.7/100 000 vs 253.9/ 100 000; P<.001), was higher among males than females (291.4 vs 244.8; P<.001), and increased with age (91.6/100 000 for persons aged <45 years, 277.2/ 100 000 for persons aged 45-64 years, and 1012.3/ 100 000 for persons aged 65 years; P<.001). Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485 000. These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18 000), Mycoplasma pneumoniae (18 700-108 000), and Chlamydia pneumoniae (5890-49 700).

Conclusions
These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia. The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.

Arch Intern Med. 1997;157:1709-1718

Footnotes
The affiliations of the authors and the Members of the Community-Based Pneumonia Incidence Study Group are listed in the acknowledgment section at the end of the article.

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