Risk Factors for Pneumonia Mortality in Primary Healthcare Hospital: A Study in Phatthana Nikhom District, Lopburi Province, Thailand
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Abstract
Background: Pneumonia remains a significant public health concern and is one of the leading causes of hospital admissions and mortality, particularly among the elderly and individuals with underlying health conditions. Recent reports indicate a rising trend in pneumonia-related mortality at Phatthana Nikhom Hospital. This study aims to identify risk factors associated with pneumonia-related deaths in a primary care setting.
Objective: This study aims to evaluate the risk factors associated with pneumonia mortality in patients admitted to Phatthana Nikhom Hospital, Lopburi Province, Thailand
Methods: A retrospective cohort study was conducted on 2,384 pneumonia patients admitted to Phatthana Nikhom Hospital, between 2019 and 2024. Multivariable competing risk regression analysis was used to evaluate demographic, clinical, and physiological risk factors associated with in-hospital mortality and referrals to higher-level care.
Result: The overall incidence of mortality was 0.9 per 100 person-days, with 186 deaths recorded. Weekend admission was associated with increased mortality risk (95% CI: 1.03-2.15, p = 0.036). Patients with a Charlson Comorbidity Index (CCI) ≥3 had significantly higher mortality risk (95% CI: 1.81-3.94, p < 0.001). Elevated Shock Index Age (SIA ≥82) (95% CI: 1.13-2.62, p = 0.011) and respiratory rate ≥30 were also significant factors.
Conclusions: Late referrals to higher-level center care, particularly among those with physiological deterioration, may contribute to increased pneumonia mortality. The high mortality rate among patients requiring CPR, a high CCI, and the weekend admission effect underscores the need for early risk-based referral decisions to prevent critical deterioration. Implementing standardized triage protocols using Shock Index Age (SIA) could help improve timely referrals and reduce pneumonia mortality rates
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