Factors Associated With In-Hospital Death Among Pneumonia Patients in US Hospitals From 2016~2019

Document Type : Original Article

Authors

1 Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea

2 Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea

3 Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea

4 School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA

5 Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, USA

Abstract

Background 
Pneumonia is one of the leading causes of hospital admission in the United States with a global health burden of about 6.8 million hospitalizations and 1.1 million deaths in patients over 65 years old in 2015. This study aimed to identify possible patient and hospital-related risk factors for in-hospital pneumonia death across US hospitals.

Methods 
The National Inpatient Sample (NIS) was used to identify nationwide pneumonia patients (n = 374 766, weighted n = 1 873 828) from 2016 to 2019. We examined the characteristics of the study sample and their association with in-hospital death. Multivariate survey logistic regression models were used to identify risk factors.

Results 
During the study periods, in-hospital death rates continuously decreased (2.45% in 2016 to 2.19% in 2019). Descriptive statistics showed that patient and hospital factors had varied in-hospital death rates. Survey logistic regression results suggested that male, very low income, non-Medicare, government hospitals, rural hospitals, and specific hospital regions were associated with higher in-hospital death rates than their reference groups.

Conclusion 
Socioeconomic factors, including income and insurance, are associated with pneumonia mortality. Census region, hospital ownership, and rural location are also related to in-hospital mortality. Such findings in underserved, impoverished, and rural areas to identify possible health disparities.

Keywords


  1. American Thoracic Society. Top 20 Pneumonia Facts-2019. ATS. https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf. Accessed March 10, 2022.
  2. Shi T, Denouel A, Tietjen AK, et al. Global and regional burden of hospital admissions for pneumonia in older adults: a systematic review and meta-analysis. J Infect Dis. 2020;222(Suppl 7):S570-S576. doi:1093/infdis/jiz053
  3. Centers for Disease Control and Prevention. Pneumonia. U.S. Department of Health and Human Services. https://www.cdc.gov/dotw/pneumonia/index.html. Published 2021. Accessed February 15, 2022.
  4. National Center for Health Statistics. Pneumonia. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/pneumonia.htm. Published February 1, 2022. Accessed February 8, 2022.
  5. Delijani K, Price MC, Little BP. Community and hospital acquired pneumonia. Semin Roentgenol. 2022;57(1):3-17. doi:1053/j.ro.2021.10.006
  6. Waterer GW, Self WH, Courtney DM, et al. In-hospital deaths among adults with community-acquired pneumonia. Chest. 2018;154(3):628-635. doi:1016/j.chest.2018.05.021
  7. Isturiz RE, Ramirez J, Self WH, et al. Pneumococcal epidemiology among us adults hospitalized for community-acquired pneumonia. Vaccine. 2019;37(25):3352-3361. doi:1016/j.vaccine.2019.04.087
  8. Zilberberg MD, Nathanson BH, Puzniak LA, Shorr AF. Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2012-2019. Crit Care Med. 2022;50(3):460-468. doi:1097/ccm.0000000000005298
  9. Giuliano KK, Baker D, Quinn B. The epidemiology of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control. 2018;46(3):322-327. doi:1016/j.ajic.2017.09.005
  10. Carey E, Chen HP, Baker D, et al. The association between non-ventilator associated hospital acquired pneumonia and patient outcomes among US Veterans. Am J Infect Control. 2022;50(12):1339-1345. doi:1016/j.ajic.2022.02.023
  11. O'Brien R, Neman T, Seltzer N, Evans L, Venkataramani A. Structural racism, economic opportunity and racial health disparities: evidence from US counties. SSM Popul Health. 2020;11:100564. doi:1016/j.ssmph.2020.100564
  12. Danziger J, Ángel Armengol de la Hoz M, Li W, et al. Temporal trends in critical care outcomes in US minority-serving hospitals. Am J Respir Crit Care Med. 2020;201(6):681-687. doi:1164/rccm.201903-0623OC
  13. Jindal RP, Gauri DK, Singh G, Nicholson S. Factors influencing hospital readmission penalties: are they really under hospitals' control? Decis Support Syst. 2018;110:58-70. doi:1016/j.dss.2018.03.006
  14. Bosco E, Zullo AR, McConeghy KW, et al. Geographic variation in pneumonia and influenza in long-term care facilities: a national study. Clin Infect Dis. 2020;71(8):e202-e205. doi:1093/cid/ciaa081
  15. Herrin J, St Andre J, Kenward K, Joshi MS, Audet AM, Hines SC. Community factors and hospital readmission rates. Health Serv Res. 2015;50(1):20-39. doi:1111/1475-6773.12177
  16. Fahrenbach J, Chin MH, Huang ES, Springman MK, Weber SG, Tung EL. Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program. Med Care. 2020;58(4):376-383. doi:1097/mlr.0000000000001283
  17. Downing NS, Wang C, Gupta A, et al. Association of racial and socioeconomic disparities with outcomes among patients hospitalized with acute myocardial infarction, heart failure, and pneumonia: an analysis of within- and between-hospital variation. JAMA Netw Open. 2018;1(5):e182044. doi:1001/jamanetworkopen.2018.2044
  18. Price MJ, De la Garza Ramos R, Dalton T, et al. Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease. Cancer Epidemiol. 2022;76:102073. doi:1016/j.canep.2021.102073
  19. Basu J, Hanchate A, Bierman A. Racial/ethnic disparities in readmissions in US hospitals: the role of insurance coverage. Inquiry. 2018;55:46958018774180. doi:1177/0046958018774180
  20. Wiemken TL, Carrico RM, Furmanek SP, et al. Socioeconomic position and the incidence, severity, and clinical outcomes of hospitalized patients with community-acquired pneumonia. Public Health Rep. 2020;135(3):364-371. doi:1177/0033354920912717
  21. Puckrein GA, Egan BM, Howard G. Social and medical determinants of cardiometabolic health: the big picture. Ethn Dis. 2015;25(4):521-524. doi:18865/ed.25.4.521
  22. Sulley S, Ndanga M. Pediatric pneumonia: an analysis of cost & outcome influencers in the United States. Int J Pediatr Adolesc Med. 2019;6(3):79-86. doi:1016/j.ijpam.2019.04.002
  23. Borsinger TM, Simon AW, Culler SD, Jevsevar DS. Does hospital teaching status matter? Impact of hospital teaching status on pattern and incidence of 90-day readmissions after primary total hip arthroplasty. Arthroplast Today. 2021;12:45-50. doi:1016/j.artd.2021.09.009
  24. Burke LG, Frakt AB, Khullar D, Orav EJ, Jha AK. Association between teaching status and mortality in US hospitals. JAMA. 2017;317(20):2105-2113. doi:1001/jama.2017.5702
  25. Paredes AZ, Hyer JM, Diaz A, Tsilimigras DI, Pawlik TM. Examining healthcare inequities relative to United States safety net hospitals. Am J Surg. 2020;220(3):525-531. doi:1016/j.amjsurg.2020.01.044
  26. Zheng M, Arora N, Chambers T, O'Dell K, Johns MM. Comparison of treatment for recurrent respiratory papillomatosis at a public county versus private academic hospital. J Voice. 2022. doi:1016/j.jvoice.2022.01.019
  27. Popescu I, Duffy E, Mendelsohn J, Escarce JJ. Racial residential segregation, socioeconomic disparities, and the White-Black survival gap. PLoS One. 2018;13(2):e0193222. doi:1371/journal.pone.0193222
  28. Semega J, Kollar M, Shrider EA, Creamer J. Income and Poverty in the United States: 2019. United States Census Bureau. https://www.census.gov/library/publications/2020/demo/p60-270.html. Published September 15, 2020. Accessed March 11, 2022.
  29. United States Census Bureau. 2019 Poverty Rate in the United States. https://www.census.gov/library/visualizations/interactive/2019-poverty-rate.html. Published September 17, 2020. Accessed March 11, 2022.
  30. Healthy People 2030. Economic Stability. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability. Accessed March 11, 2022.
  31. United States Census Bureau. Rural America. census.gov. https://mtgis-portal.geo.census.gov/arcgis/apps/MapSeries/index.html?appid=49cd4bc9c8eb444ab51218c1d5001ef6. Published 2010. Accessed February 24, 2022.
  32. Long AS, Hanlon AL, Pellegrin KL. Socioeconomic variables explain rural disparities in US mortality rates: implications for rural health research and policy. SSM Popul Health. 2018;6:72-74. doi:1016/j.ssmph.2018.08.009
  33. Vallabhajosyula S, Dunlay SM, Barsness GW, Rihal CS, Holmes DR Jr, Prasad A. Hospital-level disparities in the outcomes of acute myocardial infarction with cardiogenic shock. Am J Cardiol. 2019;124(4):491-498. doi:1016/j.amjcard.2019.05.038
  34. Hagerty V, Hospedales E, Alayon A, Samuels S, Levene T, Spader H. Association of hospital characteristics and insurance type with quality outcomes for pediatric craniosynostosis patients. Clin Neurol Neurosurg. 2021;207:106742. doi:1016/j.clineuro.2021.106742
  35. Thomas E, Yang J, Xu J, Lima FV, Stergiopoulos K. Pulmonary hypertension and pregnancy outcomes: insights from the national inpatient sample. J Am Heart Assoc. 2017;6(10):e006144. doi:1161/jaha.117.006144
  36. Khorgami Z, Aminian A, Shoar S, et al. Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample. Surg Obes Relat Dis. 2017;13(8):1284-1289. doi:1016/j.soard.2017.04.010
  37. Kabir AA, Pridjian G, Steinmann WC, Herrera EA, Khan MM. Racial differences in cesareans: an analysis of US 2001 National Inpatient Sample Data. Obstet Gynecol. 2005;105(4):710-718. doi:1097/01.AOG.0000154154.02581.ce