Marked reduction in 30-day mortality among elderly XXXX with @entity497 .

@entity1 @entity55 @entity683 @entity497 @entity204
BACKGROUND: Community-acquired @entity55 is the most common infectious cause of @entity204 in the US. Over the last 2 decades, @entity1 characteristics and clinical care have changed. To understand the impact of these changes, we quantified incidence and mortality trends among elderly adults. METHODS: We used Medicare claims to identify episodes of @entity55 , based on a validated combination of diagnosis codes. Comorbidities were ascertained using the diagnosis codes located on a 1-year look back. Trends in @entity1 characteristics and site of care were compared. The association between year of @entity55 episode and 30-day mortality was then evaluated by logistic regression, with adjustment for age, sex, and comorbidities. RESULTS: We identified 2,654,955 cases of @entity55 from 1987-2005. During this period, the proportion treated as inpatients decreased, the proportion aged >= 80 years increased, and the frequency of many comorbidities rose. Adjusted incidence increased to 3096 episodes per 100,000 population in 1999, with some decrease thereafter. Age/sex-adjusted mortality decreased from 13.5% to 9.7%, a relative reduction of 28.1%. Compared with 1987, the risk of mortality decreased through 2005 (adjusted odds ratio, 0.46; 95% confidence interval, 0.44-0.47). This result was robust to a restriction on comorbid diagnoses assessing for the results' sensitivity to increased coding. CONCLUSIONS: These findings show a marked mortality reduction over time in @entity497 @entity1 . We hypothesize that increased pneumococcal and @entity683 vaccination rates as well as wider use of guideline-concordant antibiotics explain a large portion of this trend.
