Pertussis, or whooping cough, is a highly contagious bacterial disease that affects the lungs and breathing system. Whooping cough is believed to be a childhood disease; however, adults can also be affected, although their symptoms are thought to be less severe. Among older adults (those ?50 years), particularly those with chronic conditions such as asthma or chronic obstructive pulmonary disease, there is little information on the number of people pertussis affects, or its impact on their health. Potential severe complications among these populations could lead to hospitalisation, with significant health impact on patients and economic impacts to healthcare systems. In the UK, whooping cough in older adults may not be well measured and is thought to be often underestimated.
A better understanding of the rate of whooping cough, its impact among older adults, and the characteristics of those at high risk, is necessary to develop effective approaches for better prevention, diagnosis and management of the disease. The aims of this study are therefore to assess: (1) the characteristics of older adults in the UK who are more likely to be diagnosed with whooping cough, (2) the number of older adults in the UK affected by the disease during the decade 20092018, and (3) the impact of the disease for the UK healthcare system in terms of increased resource use and costs.
Pertussis (whooping cough), a highly contagious disease caused by Bordetella pertussis, affects the respiratory system (McGuinness et al., 2013). Among older adults (those ?50 years) and particularly those with comorbidities such as chronic obstructive pulmonary disease (COPD) or asthma, there is scarce information on the incidence of pertussis, or its associated clinical and economic burden. Prior evidence suggests that potential complications among these populations could lead to hospitalisation (Buck et al., 2017; Capili et al., 2012; Pesek & Lockey, 2011). Overall, the clinical and economic burden of pertussis in older adults in the UK is considerably underestimated and not well-characterised (Caro et al.,2005; Masseria & Krishnarajah, 2015).
This primarily descriptive study plans to identify risk factors for pertussis among older adults (?50 years), and to estimate the incidence of pertussis overall in the general UK population of older adults, as well as among additional cohorts identified as being at high risk of pertussis (those with comorbid COPD, asthma, or heart failure), over a 10-year period from 2009 to 2018. Incidence rates will be stratified by age groups and by calendar year. A matched case-control study design will be used to assess risk factors for pertussis and the associated economic burden. Resource use in the primary and secondary care setting, estimated as the rate of events per patient per year accounting for differential follow-up, and associated costs per patient per year will be estimated for older adults with pertussis versus controls without pertussis. The analyses will be conducted among the overall cohort of older adults and the known high-risk cohorts (COPD, asthma, and heart failure), as well as any other newly identified high-risk cohorts.
1. Diagnosis of pertussis based on relevant Read codes, SNOMED codes and ICD-10 codes (Appendix 1).
2. Medical resource utilization (MRU) associated with occurrence of pertussis, assessed via number and proportion with at least one use of resources, and number of resources per patient per year, including:
a. GP consultations/nurse visits
b. Prescribed medications
c. Laboratory tests
d. Outpatient specialist visits
e. Accident and Emergency (A&E) visits
f. Hospital inpatient admissions (all-cause)
3. Total cost per patient per year (Pound Sterling) associated with occurrence of pertussis, assessed as the sum of costs associated with:
a. GP consultations/nurse visits
b. Prescribed medications
c. Laboratory tests
d. Outpatient specialist visits
e. A&E visits
f. Hospital inpatient admissions (all-cause)
Emmanuel ARIS - Chief Investigator - GlaxoSmithKline Biologicals SA (Belgium)
Nicola Sawalhi-Leckenby - Corresponding Applicant - Evidera, Inc
Amit Bhavsar - Collaborator - GSK
Anna Ramond - Collaborator - Evidera, Inc
Chris Colby - Collaborator - Evidera, Inc
Dimitra Lambrelli - Collaborator - Evidera, Inc
Elisa Turriani - Collaborator - GSK
Esse Ifebi Herve Akpo - Collaborator - GSK
Evie Merinopoulou - Collaborator - Evidera, Inc
Germain Lonnet - Collaborator - GSK
Jason Simeone - Collaborator - Evidera, Inc
Kinga Meszaros - Collaborator - GSK
Lauriane Harrington - Collaborator - GSK
Nathalie Servotte - Collaborator - GlaxoSmithKline Biologicals SA (Belgium)
Noami Berfeld - Collaborator - Evidera, Inc
Piyali Mukherjee - Collaborator - GSK
Robert Donaldson - Collaborator - Evidera Ltd - UK
Sharon MacLachlan - Collaborator - Evidera, Inc
Yves BRABANT - Collaborator - GlaxoSmithKline Biologicals SA (Belgium)
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation