Publicação
Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal
| Resumo: | Background: Community-Acquired Pneumonia (CAP) is regarded as a substantial part of the global burden of disease and a public health priority. In addition to host factors, such as demographic characteristics, comorbidities, CAP clinical severity, and in-hospital mortality may also be influenced by factors such as socioeconomic status, seasonal variations, and hospital differentiation. This study aims to analyse trends in hospital mortality among patients hospitalized with CAP in National Health Service (NHS) hospitals in mainland Portugal and the impact of various host and environmental factors on in-hospital mortality. METHODS: This retrospective cross-sectional study analyzed 378,449 hospitalization episodes with CAP as the primary diagnosis (ICD-9-CM and ICD-10-CM/PCS) in mainland Portugal from 2010 to 2018. Data were sourced from the National Hospital Discharge Database and population census records. Variables included host factors (demographic characteristics, secondary diagnoses, CAP clinical severity indicators, Charlson score) as well as environmental factors, such as seasonality, socioeconomic factors and hospital differentiation. Trend analysis of hospitalization episodes and in-hospital mortality due to CAP was performed. Multivariable logistic regression was used to examine associations with in-hospital mortality, with statistical significance set at p < 0.05. Results: A decrease in the number of hospitalization episodes and in-hospital mortality rate over time was observed. The regression model identified advanced age, male gender, secondary diagnoses, CAP clinical severity, high Charlson score, the summer season, early school leaving rate, higher unemployment rate, and lower hospital differentiation as factors associated with an increased probability of death (p < 0.001). CONCLUSIONS: Throughout the nine-year period, a steady decline in in-hospital mortality rates was observed. In-hospital mortality exhibited a dual influence, shaped by host factors (such as age, gender, secondary diagnoses, CAP clinical severity, Charlson score) and environmental factors, including the summer season, socioeconomic vulnerability and hospital capabilities. Therefore, effectively reducing CAP in-hospital mortality requires comprehensive policies that focus on at-risk groups and address a broad range of both host and environmental risk factors. These policies should aim to improve healthcare access, increase vaccination coverage, and enhance thermal housing conditions, with particular attention to socially vulnerable individuals. |
|---|---|
| Autores principais: | Pessoa, Ezequiel |
| Outros Autores: | Bárbara, Cristina; Costa, Andreia; Nogueira, Paulo Jorge |
| Assunto: | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| _version_ | 1866809811026313216 |
|---|---|
| author | Pessoa, Ezequiel |
| author2 | Bárbara, Cristina Costa, Andreia Nogueira, Paulo Jorge |
| author2_role | author author author |
| author_facet | Pessoa, Ezequiel Bárbara, Cristina Costa, Andreia Nogueira, Paulo Jorge |
| author_role | author |
| contributor_name_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Pessoa, Ezequiel\",\"Person.identifier.orcid\":\"0000-0002-0756-2693\"},{\"Person.name\":\"Bárbara, Cristina\",\"Person.identifier.orcid\":\"0000-0003-0915-4105\"},{\"Person.name\":\"Costa, Andreia\",\"Person.identifier.orcid\":\"0000-0002-2727-4402\"},{\"Person.name\":\"Nogueira, Paulo Jorge\",\"Person.identifier.orcid\":\"0000-0001-8316-5035\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| datacite.creators.creator.creatorName.fl_str_mv | Pessoa, Ezequiel Bárbara, Cristina Costa, Andreia Nogueira, Paulo Jorge |
| datacite.date.Accepted.fl_str_mv | 2025-01-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2025-06-17T13:08:49Z |
| datacite.date.embargoed.fl_str_mv | 2025-06-17T13:08:49Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| datacite.titles.title.fl_str_mv | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| dc.contributor.none.fl_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| dc.creator.none.fl_str_mv | Pessoa, Ezequiel Bárbara, Cristina Costa, Andreia Nogueira, Paulo Jorge |
| dc.date.Accepted.fl_str_mv | 2025-01-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2025-06-17T13:08:49Z |
| dc.date.embargoed.fl_str_mv | 2025-06-17T13:08:49Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10400.5/101596 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Springer Nature |
| dc.rights.cclincense.fl_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| dc.title.fl_str_mv | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: Community-Acquired Pneumonia (CAP) is regarded as a substantial part of the global burden of disease and a public health priority. In addition to host factors, such as demographic characteristics, comorbidities, CAP clinical severity, and in-hospital mortality may also be influenced by factors such as socioeconomic status, seasonal variations, and hospital differentiation. This study aims to analyse trends in hospital mortality among patients hospitalized with CAP in National Health Service (NHS) hospitals in mainland Portugal and the impact of various host and environmental factors on in-hospital mortality. METHODS: This retrospective cross-sectional study analyzed 378,449 hospitalization episodes with CAP as the primary diagnosis (ICD-9-CM and ICD-10-CM/PCS) in mainland Portugal from 2010 to 2018. Data were sourced from the National Hospital Discharge Database and population census records. Variables included host factors (demographic characteristics, secondary diagnoses, CAP clinical severity indicators, Charlson score) as well as environmental factors, such as seasonality, socioeconomic factors and hospital differentiation. Trend analysis of hospitalization episodes and in-hospital mortality due to CAP was performed. Multivariable logistic regression was used to examine associations with in-hospital mortality, with statistical significance set at p < 0.05. Results: A decrease in the number of hospitalization episodes and in-hospital mortality rate over time was observed. The regression model identified advanced age, male gender, secondary diagnoses, CAP clinical severity, high Charlson score, the summer season, early school leaving rate, higher unemployment rate, and lower hospital differentiation as factors associated with an increased probability of death (p < 0.001). CONCLUSIONS: Throughout the nine-year period, a steady decline in in-hospital mortality rates was observed. In-hospital mortality exhibited a dual influence, shaped by host factors (such as age, gender, secondary diagnoses, CAP clinical severity, Charlson score) and environmental factors, including the summer season, socioeconomic vulnerability and hospital capabilities. Therefore, effectively reducing CAP in-hospital mortality requires comprehensive policies that focus on at-risk groups and address a broad range of both host and environmental risk factors. These policies should aim to improve healthcare access, increase vaccination coverage, and enhance thermal housing conditions, with particular attention to socially vulnerable individuals. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | article |
| fulltext.url.fl_str_mv | https://repositorio.ulisboa.pt/bitstreams/3a2d5d5f-2b6d-4f04-9483-d437733c9e91/download |
| id | ul_bbae8ab558b41b85cc8dcdfe7860d28e |
| identifier.url.fl_str_mv | http://hdl.handle.net/10400.5/101596 |
| instacron_str | ul |
| institution | Universidade de Lisboa |
| instname_str | Universidade de Lisboa |
| language | eng |
| network_acronym_str | ul |
| network_name_str | Repositório da Universidade de Lisboa |
| oai_identifier_str | oai:repositorio.ulisboa.pt:10400.5/101596 |
| organization_str_mv | urn:organizationAcronym:ul |
| person_str_mv | Pessoa, Ezequiel Pessoa, Ezequiel https://www.ciencia-id.pt/8B14-6052-FB9C 8B14-6052-FB9C http://orcid.org/0000-0002-0756-2693 0000-0002-0756-2693 Bárbara, Cristina Bárbara, Cristina https://www.ciencia-id.pt/171F-DE21-B23B 171F-DE21-B23B http://orcid.org/0000-0003-0915-4105 0000-0003-0915-4105 Costa, Andreia Costa, Andreia https://www.ciencia-id.pt/071D-4FEB-416D 071D-4FEB-416D http://orcid.org/0000-0002-2727-4402 0000-0002-2727-4402 Nogueira, Paulo Jorge Nogueira, Paulo Jorge https://www.ciencia-id.pt/2410-2DCC-F213 2410-2DCC-F213 http://orcid.org/0000-0001-8316-5035 0000-0001-8316-5035 |
| publishDate | 2025 |
| publisher.none.fl_str_mv | Springer Nature |
| reponame_str | Repositório da Universidade de Lisboa |
| repository_id_str | urn:repositoryAcronym:ul |
| service_str_mv | urn:repositoryAcronym:ul |
| spelling | engSpringer Naturept_PTBackground: Community-Acquired Pneumonia (CAP) is regarded as a substantial part of the global burden of disease and a public health priority. In addition to host factors, such as demographic characteristics, comorbidities, CAP clinical severity, and in-hospital mortality may also be influenced by factors such as socioeconomic status, seasonal variations, and hospital differentiation. This study aims to analyse trends in hospital mortality among patients hospitalized with CAP in National Health Service (NHS) hospitals in mainland Portugal and the impact of various host and environmental factors on in-hospital mortality. METHODS: This retrospective cross-sectional study analyzed 378,449 hospitalization episodes with CAP as the primary diagnosis (ICD-9-CM and ICD-10-CM/PCS) in mainland Portugal from 2010 to 2018. Data were sourced from the National Hospital Discharge Database and population census records. Variables included host factors (demographic characteristics, secondary diagnoses, CAP clinical severity indicators, Charlson score) as well as environmental factors, such as seasonality, socioeconomic factors and hospital differentiation. Trend analysis of hospitalization episodes and in-hospital mortality due to CAP was performed. Multivariable logistic regression was used to examine associations with in-hospital mortality, with statistical significance set at p < 0.05. Results: A decrease in the number of hospitalization episodes and in-hospital mortality rate over time was observed. The regression model identified advanced age, male gender, secondary diagnoses, CAP clinical severity, high Charlson score, the summer season, early school leaving rate, higher unemployment rate, and lower hospital differentiation as factors associated with an increased probability of death (p < 0.001). CONCLUSIONS: Throughout the nine-year period, a steady decline in in-hospital mortality rates was observed. In-hospital mortality exhibited a dual influence, shaped by host factors (such as age, gender, secondary diagnoses, CAP clinical severity, Charlson score) and environmental factors, including the summer season, socioeconomic vulnerability and hospital capabilities. Therefore, effectively reducing CAP in-hospital mortality requires comprehensive policies that focus on at-risk groups and address a broad range of both host and environmental risk factors. These policies should aim to improve healthcare access, increase vaccination coverage, and enhance thermal housing conditions, with particular attention to socially vulnerable individuals.application/pdfpt_PTHost and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in PortugalPersonalPessoa, EzequielDSpacehttp://dspace.org/items/275236c6-a424-4992-98ce-c8e91e6824f7DSpacehttp://dspace.org/items/275236c6-a424-4992-98ce-c8e91e6824f7PessoaEzequielCiência IDhttps://www.ciencia-id.pt8B14-6052-FB9CORCIDhttp://orcid.org0000-0002-0756-2693PersonalBárbara, CristinaDSpacehttp://dspace.org/items/a16c0cb5-c7f4-4cca-b9f9-bbeb6d35c474DSpacehttp://dspace.org/items/a16c0cb5-c7f4-4cca-b9f9-bbeb6d35c474BárbaraCristinaCiência IDhttps://www.ciencia-id.pt171F-DE21-B23BORCIDhttp://orcid.org0000-0003-0915-4105Scopus Author IDhttps://www.scopus.com6701574502PersonalCosta, AndreiaDSpacehttp://dspace.org/items/0e0f9040-c74f-45b1-99ec-d7e6e22213c3DSpacehttp://dspace.org/items/0e0f9040-c74f-45b1-99ec-d7e6e22213c3Jorge Silva da CostaAndreiaCiência IDhttps://www.ciencia-id.pt071D-4FEB-416DORCIDhttp://orcid.org0000-0002-2727-4402Scopus Author IDhttps://www.scopus.com57221614154PersonalNogueira, Paulo JorgeDSpacehttp://dspace.org/items/9d24d0e5-5fab-4fef-b962-b0333e28f9d1DSpacehttp://dspace.org/items/9d24d0e5-5fab-4fef-b962-b0333e28f9d1NogueiraPaulo JorgeCiência IDhttps://www.ciencia-id.pt2410-2DCC-F213ORCIDhttp://orcid.org0000-0001-8316-5035Researcher IDhttps://www.researcherid.comAAR-5605-2020Scopus Author IDhttps://www.scopus.com7005428250Scopus Author IDhttps://www.scopus.com57211297445HostingInstitutionOrganizationalRepositório Científico de Acesso Aberto da ULisboae-mailmailto:repositorio@reitoria.ulisboa.ptrepositorio@reitoria.ulisboa.ptDOIIsPartOf10.1186/s12890-025-03716-82025-06-17T13:08:49Z20252025-01-01T00:00:00ZHandlehttp://hdl.handle.net/10400.5/101596http://purl.org/coar/access_right/c_abf2open accessAge factorsCommunity-Acquired PneumoniaComorbidityGenderHospital mortalityLow socioeconomic statusRisk factorsWeather2079661 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal article2025http://creativecommons.org/licenses/by/4.0/http://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://repositorio.ulisboa.pt/bitstreams/3a2d5d5f-2b6d-4f04-9483-d437733c9e91/downloadBMC Pulmonary Medicine251 |
| spellingShingle | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal Pessoa, Ezequiel Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| status | SINGLETON |
| subject.fl_str_mv | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| title | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| title_full | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| title_fullStr | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| title_full_unstemmed | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| title_short | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| title_sort | Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in Portugal |
| topic | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| topic_facet | Age factors Community-Acquired Pneumonia Comorbidity Gender Hospital mortality Low socioeconomic status Risk factors Weather |
| url | http://hdl.handle.net/10400.5/101596 |
| visible | 1 |