A Retrospective Study of the Clinical Burden of Hospitalized All-Cause and Pneumococcal Pneumonia in Canada

Table 3

Summary of practices and policy changes that could account for declining pneumonia rates in Canadianadults ≥65 years old.

Factor	Can this explain the decline in all-cause pneumonia between 2004 and 2010 in adults aged ≥65 years?	Reference
Changes in ICD-10 coding practices	No. Would expect changes in all ages groups	NA
Increased use of fluoroquinolones for lower respiratory tract infection	Maybe. Fluoroquinolone scripts were up in 2004-2005 but down again in 2008-2009	[24, 25]
Smoking amongst adults aged ≥65 years	No. Smoking remained constant at approximately 11%	Compare [26] with [27]
Pneumovax vaccination	No. PPSV23 immunization rates in adults aged ≥65 years were stable between 2006 and 2010 at approximately 38%	[28]
Influenza vaccination	No. Influenza immunization declined from 69.9% in 2006 to 52.8% in 2010 in adults aged ≥65 years	[28]
New clinical pathway for treatment in long-term care facilities, rather than in the hospital	No. Decline began before publication of protocol	[29]
Change in Infectious Disease Society of America Guidelines for the management of community-acquired pneumonia	No. Decline began before publication of guidelines	[30]
New guidelines for the treatment of acute exacerbations of chronic bronchitis	Yes. Focused antibiotic treatment of Groups 2 and 3 AECOPD published in 2003	[22]

AECOPD: acute exacerbations of chronic obstructive pulmonary disease; ICD: International Classification of Diseases; NA: not applicable; PPSV23: 23-valent pneumococcal polysaccharide vaccine.