Time trends in incidence and outcomes of hospitalizations for aspiration pneumonia among elderly people in Spain (2003−2013)

Published:January 05, 2017DOI:


      • Aspiration pneumonia is an infectious process causing high rates of mortality.
      • Older people had longer hospital stay, readmissions, and in-hospital mortality.
      • An observational study with older patients between 2003 and 2013 was conducted.
      • Length of hospital stay and in-hospital mortality decreased in both sexes.
      • Readmissions increased significantly in women.



      Aspiration pneumonia (AP) is an infectious process causing high rates of mortality. The purpose of this study was: 1, to describe the incidence from 2003 to 2013 of AP hospitalizations; 2, to assess time trends in hospital outcomes variables, and; 3, to identify the factors independently associated with in-hospital mortality (IHM).


      A retrospective observational study using the Spanish National Hospital Database, with patients discharged between January 2003 and December 2013 was conducted. Inclusion criteria were: Subjects aged 75 years or older whose medical diagnosis included AP events code according to the ICD-9-CM: 507.x in the primary diagnosis field. Patient variables, up to 14 discharge diagnoses per patient, and up to 20 procedures performed during the hospital stay (ICD-9-CM), Charlson Comorbidity Index, readmission, length of hospital stay (LOHS), and IHM were analyzed.


      We included 111,319 admissions (53.13% women). LOHS decreased in both sexes (P < 0.001) and was significantly higher in men (10.4 ± 10.31 vs. 9.56 ± 10.02 days). Readmissions increased significantly in women during the study (13.94% in 2003 to 16.41% in 2013, P < 0.001). In both sex, IHM was significantly higher in >94 years old subjects (OR: 1.43, 95%CI 1.36–1.51) and in those with readmissions (OR: 1.20, 95%CI 1.15–1.23). For the entire population, time trend analyses showed a significant decrease in mortality from 2003 to 2013 (OR: 0.96, 95%CI 0.95–0.97).


      Patients with AP are older, male, and have more comorbidities than those without AP. Over time, LOHS and IHM decreased in both sexes, but readmissions increased significantly in women.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Taylor J.K.
        • Fleming G.B.
        • Singanayagam A.
        • Hill A.T.
        • Chalmers J.D.
        Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort.
        Am J Med. 2013; 126: 995-1001
        • Marik E.
        Aspiration syndromes: aspiration pneumonia and pneumonitis.
        Hosp Pract. 2010; 38: 35-42
        • Marik P.E.
        Pulmonary aspiration syndromes.
        Curr Opin Pulm Med. 2011; 17: 148-154
        • DiBardino D.M.
        • Wunderink R.G.
        Aspiration pneumonia: a review of modern trends.
        J Crit Care. 2015; 30: 40-48
        • Bosch X.
        • Formiga F.
        • Cuerpo S.
        • Torres B.
        • Rosón B.
        • López-Soto A.
        Aspiration pneumonia in old patients with dementia. Prognostic factors of mortality.
        Eur J Intern Med. 2012; 23: 720-726
        • Hayashi M.
        • Iwasaki T.
        • Yamazaki Y.
        • Takayasu H.
        • Tateno H.
        • Tazawa S.
        • et al.
        Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study.
        J Infect Chemother. 2014; 20: 436-442
        • Lanspa M.J.
        • Jones B.E.
        • Brown S.M.
        • Dean N.C.
        Mortality, morbidity, and disease severity of patients with aspiration pneumonia.
        J Hosp Med. 2013; 8: 83-90
        • Baztán Cortés J.J.
        • Perdomo Ramírez B.
        • Socorro García A.
        • Álvarez de Abajo F.
        • Ruipérez Cantera I.
        Prognostic value of the primary diagnosis in elderly patients admitted to an acute geriatric unit at discharge and one year later.
        Rev Esp Geriatr Gerontol. 2016; 51: 11-17
        • Teramoto S.
        • Fukuchi Y.
        • Sasaki H.
        • Sato K.
        • Sekizawa K.
        • Matsuse T.
        • et al.
        High incidence of aspiration pneumonia in community-and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan.
        J Am Geriatr Soc. 2008; 56: 577-579
        • Yamauchi Y.
        • Yasunaga H.
        • Matsui H.
        • Hasegawa W.
        • Jo T.
        • Takami K.
        • et al.
        Comparison of clinical characteristics and outcomes between aspiration pneumonia and community-acquired pneumonia in patients with chronic obstructive pulmonary disease.
        BMC Pulm Med. 2015; 15: 69
        • Komiya K.
        • Ishii H.
        • Umeki K.
        • Mizunoe S.
        • Okada F.
        • Johkoh T.
        • et al.
        Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: a multicenter retrospective cohort study.
        Respirology. 2013; 18: 514-521
        • Lanspa M.J.
        • Peyrani P.
        • Wiemken T.
        • Wilson E.L.
        • Ramirez J.A.
        • Dean N.C.
        Characteristics associated with clinician diagnosis of aspiration pneumonia; a descriptive study of afflicted patients and their outcomes.
        J Hosp Med. 2015; 10: 90-96
        • Akbar U.
        • Dham B.
        • He Y.
        • Hack N.
        • Wu S.
        • Troche M.
        • et al.
        Incidence and mortality trends of aspiration pneumonia in Parkinson's disease in the United States, 1979–2010.
        Parkinsonism Relat Disord. 2015; 21: 1082-1086
        • Xu B.
        • Boero I.J.
        • Hwang L.
        • Le Q.T.
        • Moiseenko V.
        • Sanghvi P.R.
        • et al.
        Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer.
        Cancer. 2015; 121: 1303-1311
        • Manabe T.
        • Teramoto S.
        • Tamiya N.
        • Okochi J.
        • Hizawa N.
        Risk factors for aspiration pneumonia in older adults.
        PLoS One. 2015; 10e0140060
        • van der Maarel-Wierink C.D.
        • Vanobbergen J.N.
        • Bronkhorst E.M.
        • Schols J.M.
        • de Baat C.
        Risk factors for aspiration pneumonia in frail older people: a systematic literature review.
        J Am Med Dir Assoc. 2011; 12: 344-354
        • Ramos A.
        • Asensio A.
        • Caballos D.
        • Mariño M.J.
        Prognostic factors associated with community-acquired aspiration pneumonia.
        Med Clin (Barc). 2002; 119: 81-84
        • Pinargote H.
        • Ramos J.M.
        • Zurita A.
        • Portilla J.
        Clinical features and outcomes of aspiration pneumonia and non-aspiration pneumonia in octogenarians and nonagenarians admitted in a General Internal Medicine Unit.
        Rev Esp Quimioter. 2015; 28: 310-313
        • Kozlow J.H.
        • Berenholtz S.M.
        • Garrett E.
        • Dorman T.
        • Pronovost P.J.
        Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000.
        Crit Care Med. 2003; 31: 1930-1937
        • Instituto Nacional de Gestión Sanitaria, Ministerio de Sanidad, Servicios Sociales e Igualdad
        Conjunto Mínimo Básico de Datos.
        Hospitales del INSALUD, 2016 ([cited 2016 October 10]. Available from)
        • Stukenborg G.J.
        • Wagner D.P.
        • Harrell Jr., F.E.
        • Oliver M.N.
        • Kilbridge K.L.
        • Lyman J.
        • et al.
        Hospital discharge abstract data on comorbidity improved the prediction of death among patients hospitalized with aspiration pneumonia.
        J Clin Epidemiol. 2004; 57: 522-532
        • Buck C.J.
        • Netter F.H.
        • American Medical Association
        ICD-9-M for Hospitals.
        Professionals ed. vol. 1, 2, & 3. Elsevier, St. Louis, Mo2013: 2013
        • McCarthy E.P.
        • Iezzoni L.I.
        • Davis R.B.
        • Palmer R.H.
        • Cahalane M.
        • Hamel M.B.
        • et al.
        Does clinical evidence support ICD-9-CM diagnosis coding of complications?.
        Med Care. 2000; 38: 868-876
        • Quan H.
        • Parsons G.A.
        • Ghali W.A.
        Validity of information on comorbidity derived from ICD-9-CCM administrative data.
        Med Care. 2002; 40: 675-685
        • Instituto Nacional de Estadística
        Population Estimates.
        ([cited 2016 October 10]Available from)
        • Hosmer D.W.
        • Lemeshow S.
        Applied Logistic Regression.
        2nd ed. John Wiley & Sons, New York2004
        • Corrao S.
        • Santalucia P.
        • Argano C.
        • Djade C.D.
        • Barone E.
        • Tettamanti M.
        • REPOSI Investigators
        • et al.
        Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study.
        Eur J Intern Med. 2014; 25: 617-623
        • Dìez-Manglano J.
        • de Escalante Y.B.
        • Garcìa-Arilla Calvo E.
        • Ubis Diez E.
        • Munilla Lòpez E.
        • Clerencia Sierra M.
        • et al.
        Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.
        Eur J Intern Med. 2013; 24: 767-771
        • Komiya K.
        C-reactive protein as a prognostic factors in elderly patients with aspiration penumonia.
        Eur J Intern Med. 2013; 24: e88-e89
        • DeLegge M.H.
        Aspiration pneumonia: incidence, mortality, and at-risk populations.
        JPEN J Parenter Enteral Nutr. 2002; 26 (discussion S24–5): S19-S24
        • Lee H.W.
        • Min J.
        • Park J.
        • Lee Y.J.
        • Lee Y.J.
        • Kim S.J.
        • et al.
        Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia.
        Respirology. 2015; 20: 1115-1122
        • Fujita Y.
        • Inoue K.
        A report summarizing measures formulated to prevent aspiration pneumonia.
        West Indian Med J. 2011; 60: 371-372
        • Momosaki R.
        • Yasunaga H.
        • Matsui H.
        • Horiguchi H.
        • Fushimi K.
        • Abo M.
        Effect of early rehabilitation by physical therapists on in-hospital mortality after aspiration pneumonia in the elderly.
        Arch Phys Med Rehabil. 2015; 96: 205-209
        • Morley J.E.
        Dysphagia and aspiration.
        J Am Med Dir Assoc. 2015; 16: 631-634
        • Caldeira D.
        • Alarcão J.
        • Vaz-Carneiro A.
        • Costa J.
        Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis.
        BMJ. 2012; 345e4260
        • Cabré M.
        • Serra-Prat M.
        • Force L.
        • Almirall J.
        • Palomera E.
        • Clavé P.
        Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 330-337