Studying the burden of community-acquired pneumonia in adults aged ≥ 50 years in primary health care: an observational study in rural Crete, Greece

BACKGROUND: Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities. AIMS: The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants. METHODS: An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece. Eligible patients were those aged 50 years or above, presenting with CAP based on signs and symptoms and positive X-ray findings. RESULTS: A total of 124 CAP cases were recorded, 40 of which (32.3%) were hospitalised. The age-standardised CAP incidence was estimated to be 236.7 cases per 100,000 persons aged >= 50 years. Forty-three patients (35.2%) were vaccinated against pneumococcus. The most frequent chronic illnesses were heart disease (64.5%), chronic obstructive pulmonary disease (32.5%), and type 2 diabetes (21%). Hospitalisation determinants included advanced age (>= 74 years, Odds ratio (OR) 7.13; P value = 0.001; 95% confidence interval (CI), 2.23-22.79), obesity (OR 3.36, P = 0.037; 95% CI, 1.08-10.52), >= 40 pack-years of smoking (OR 3.82, P value = 0.040; 95% CI, 1.07-18.42), presence of multimorbidity (OR 5.77, P value = 0.003; 95% CI, 1.81-18.42) and pneumococcal vaccination (OR 0.29, P value = 0.041; 95% CI, 0.09-0.95). CONCLUSIONS: This study highlighted patient characteristics and aspects of CAP epidemiology in the context of a rural primary care setting in southern Europe where limited data have been published until now.