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Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in three cities in South America
  1. Gustavo Daniel Lopardo1,
  2. Diego Fridman1,
  3. Enrique Raimondo2,
  4. Henry Albornoz3,
  5. Ana Lopardo1,
  6. Homero Bagnulo4,
  7. Daniel Goleniuk5,
  8. Manuelita Sanabria6,
  9. Daniel Stamboulian1
    1. 1 Fundación del Centro de Estudios Infectológicos, Buenos Aires, Argentina
    2. 2 Department of Infectious Diseases, Hospital López Lima, General Roca, Argentina
    3. 3 Department of Infectious Diseases, Universidad de la República, Hospital Maciel, Montevideo, Uruguay
    4. 4 Hospital Maciel, Montevideo, Uruguay
    5. 5 Sanatorio Casmer Femi, Rivera, Uruguay
    6. 6 Department of Internal Medicine, Hospital Regional Concepción. Instituto de Previsión Social, Concepción, Paraguay
    1. Correspondence to Dr Gustavo Daniel Lopardo; glopardo{at}


    Objective To determine the incidence rate and mortality of community-acquired pneumonia (CAP) in adults in three cities in Latin America during a 3-year period.

    Design Prospective population-based surveillance study.

    Setting Healthcare facilities (outpatient centres and hospitals) in the cities of General Roca (Argentina), Rivera (Uruguay) and Concepción (Paraguay).

    Participants 2302 adults aged 18 years and older with CAP were prospectively enrolled between January 2012 and March 2015.

    Main outcome measures Incidence rates of CAP in adults, predisposing conditions for disease, mortality at 14 days and at 1 year were estimated. Incidence rate of CAP, within each age group, was calculated by dividing the number of cases by the person-years of disease-free exposure time based on the last census; incidence rates were expressed per 1000 person-years.

    Results Median age of participants was 66 years, 46.44% were men, 68% were hospitalised. Annual incidence rate was 7.03 (95% CI 6.64 to 7.44) per 1000 person-years in General Roca, 6.33 (95% CI 5.92 to 6.78) per 1000 person-years in Rivera and 1.76 (95% CI 1.55 to 2.00) per 1000 person-years in Concepción. Incidence rates were highest in participants aged over 65 years. 82.4% had at least one predisposing condition and 48% had two or more (multimorbidity). Chronic heart disease (43.6%) and smoking (37.3%) were the most common risk factors. 14-day mortality rate was 12.1% and 1-year mortality was 24.9%. Multimorbidity was associated with an increased risk of death at 14 days (OR 2.91; 95% CI 2.23 to 3.80) and at 1 year (OR 3.00; 95% CI 2.44 to 3.70).

    Conclusions We found a high incidence rate of CAP in adults, ranging from 1.76 to 7.03 per 1000 person-years, in three cities in South America, disclosing the high burden of disease in the region. Efforts to improve prevention strategies are needed.

    • community-acquiered pneumonia
    • incidence rate
    • mortality

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    • Contributors All authors involved in this study played a significant role and abided to the ICMJE guidelines. They all had substantial contributions to conception and design, acquisition of data and analysis and interpretation of data; drafting the article and revising it critically for important intellectual content and final approval of the version to be published. GDL, DF and DS were responsible for the study design, statistical analysis, interpretation of data and drafting the manuscript. ER, DG, HA, HB and MS were responsible for data collection, analysis and final approval. AL participated in the study as coordinator and reviewed the manuscript. All authors contributed to the critical revision of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. GDL is the guarantor.

    • Funding This study was supported by an unrestricted grant from Pfizer Inc. Thefunder had no role in study design, data collection and analysis, orpreparation of the manuscript for publication.

    • Competing interests GDL and DS have received travel expenses and have been paid for delivering educational presentations for Pfizer; HA has received travel expenses from Pfizer.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval This study was approved by the institutional review board at FUNCEI.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Extra data can be accessed via the Dryad data repository at with the doi: 10.5061/dryad.r282vk6

    • Collaborators Pablo Luchetti, Cynthia Vartalitis.