(32) Age- and Gender-specific Epidemiology of Urinary Tract Infection, Pneumonia, Sepsis, Cholecystytis and Cellulitis Among the Elderly: A 20-Year Nationwide Study

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 363

Presenting Author(s)

HUNG-YU LIN
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan

Co-Author(s)

Shih-Tsung Huang, PharmD
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
Liang-Kung Chen
– Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan, Taipei, Taiwan, Taiwan (Republic of China)
Fei-Yuan Hsiao
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)

Background: Being a vulnerable population, the elderly is susceptible to numerous infections, such as urinary tract infection (UTI) and pneumonia, which results in considerable clinical and economic burden. However, a comprehensive analysis to capture major infections among the elderly is very limited.

Objectives: This study aimed to estimate age- and gender-specific incidence of infections, including UTI, pneumonia, sepsis, cellulitis and cholecystitis, and to investigate the economic burden of each infection (for both incident and recurrent episodes) among the elderly in Taiwan.

Methods: We identified individuals aged 65 years old and older from the National Health Insurance Research Database between 2000 and 2019 in Taiwan. Nine pre-selected infection episodes (UTI, pneumonia, sepsis, cellulitis, cholecystitis, bloodstream infection, endocarditis peritonitis and meningitis) were identified by any admission with corresponding diagnosis codes (ICD-9 or ICD-10). The incidence rate (per 1,000 persons) for each infection were calculated annually within different age and gender groups. For economic burden, direct medical costs and length of stay were estimated for the index event (the first episode within study period of each enrollee) and subsequent events. In addition, time interval between each event were also presented.

Results: The incidence of all selected infections was 78.4 and 86.9 (/1,000 persons) in females and males during our study period. The incidence of infection in women aged 65-74, 75-84, and 85+ was 45.4, 101.1, and 200.5 (/1,000 persons), respectively, while in men was 52.1, 114.0, and 211.9 (/1,000 persons). UTI was the most common infection in old women (45.5/1,000 persons), while pneumonia was the most prevalent one in old men (48.1/1,000 persons). The medical costs of an infection admission in older adults was USD $1,474 (mean, Q1-Q3: 752-3,298), and 21.32% of them had been admitted in intensive care units. After the index event, 57.6% patients had the subsequent infection episode, with the time from the index event as 337 days (mean, Q1-Q3: 58-1,127) and the medical costs increased from USD $1,323 (mean, Q1-Q3: 656-3,145) in index event to $1,450 (mean, Q1-Q3: 738-3,296) in subsequent event.

Conclusions: Overall, the incidence of infection was higher in old men than women in all age groups, and increased with age. UTI and pneumonia were the two dominant infections in the elderly. Recurrent infections has incurred significant clinical and economic burden. A comprehensive geriatric assessment should consider the impact of infection on clinical outcomes of older adults.