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      Infectious Disease-Related Emergency Department Visits of Elderly Adults in the United States, 2011-2012

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          Abstract

          To investigate the frequency of infectious disease (ID)-related emergency department (ED) visits of elderly adults in the United States.

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          Effectiveness of influenza vaccine in the community-dwelling elderly.

          Kristin L. Nichol, James Nordin, David Nelson … (2007)
          Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990-1991 through 1999-2000 and of two other HMOs for 1996-1997 through 1999-2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant--though lower--reductions in the risks of both hospitalization and death. During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. Copyright 2007 Massachusetts Medical Society.
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            Trends in infectious disease mortality in the United States during the 20th century.

            Gregory Armstrong (1999)
            Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends. To describe trends in infectious disease mortality in the United States during the 20th century. Descriptive study of infectious disease mortality in the United States. Deaths due to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends in age-specific infectious disease mortality were examined by using age-specific death rates for 9 common infectious causes of death. Persons who died in the United States between 1900 and 1996. Crude and age-adjusted mortality rates. Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible for the largest number of infectious disease deaths throughout the century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older and was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths among persons aged 65 years and older. There was considerable year-to-year variability in infectious disease mortality, especially for the youngest and oldest age groups. Although most of the 20th century has been marked by declining infectious disease mortality, substantial year-to-year variation as well as recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.
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              Trends in US Hospital Admissions for Skin and Soft Tissue Infections

              John Edelsberg, Charu Taneja, Marcus J Zervos … (2009)
              Using data from the 2000–2004 US Healthcare Cost and Utilization Project National Inpatient Sample, we found that total hospital admissions for skin and soft tissue infections increased by 29% during 2000–2004; admissions for pneumonia were largely unchanged. These results are consistent with recent reported increases in community-associated methicillin-resistant Staphylococcus aureus infections.
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                Author and article information

                Journal
                Title: Journal of the American Geriatrics Society
                Abbreviated Title: J Am Geriatr Soc
                Publisher: Wiley
                ISSN: 00028614
                Publication date Created: January 2016
                Publication date (Print): January 2016
                Publication date (Electronic): December 23 2015
                Volume: 64
                Issue: 1
                Pages: 31-36
                Affiliations
                [1 ]Department of Emergency Medicine; University of Fukui Hospital; Fukui Japan
                [2 ]Department of Emergency Medicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
                [3 ]Department of Epidemiology; T. H. Chan School of Public Health; Harvard University; Boston Massachusetts
                [4 ]Harvard Interfaculty Initiative in Health Policy; Harvard University; Boston Massachusetts
                Article
                DOI: 10.1111/jgs.13836
                PubMed ID: 26696501
                SO-VID: 1ba8cce9-9076-452e-9115-845436d42b87
                Copyright © © 2015
                License:

                http://doi.wiley.com/10.1002/tdm_license_1.1

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