The impact of painful musculoskeletal conditions on outcomes of community-acquired pneumonia

Date of Approval
Application Number
Technical Summary

In older adults with newly diagnosed conditions, comorbid musculoskeletal pain is common but often neglected. Musculoskeletal comorbidity could adversely impact outcomes if pain, and associated restricted functioning and sleep interference, prevent or delay delivery of appropriate treatment or reduce its effectiveness. It may increase the risk of hospitalisation for morbidities which may otherwise have been treated in primary care. As the final part of a series of four different clinical cohorts, we wish to investigate whether there is an impact of musculoskeletal comorbidity on outcomes in patients with community-acquired pneumonia. Using CPRD Aurum, HES admitted patient data and ONS mortality records, we will analyse data of patients newly diagnosed with community-acquired pneumonia and compare patients with a prior painful musculoskeletal condition requiring health care to patients without on the risk of hospitalisation, duration of hospitalisation, risk of readmission within 30 days after discharge, short term mortality, resource use and costs. Painful musculoskeletal conditions will be identified from primary care records in the 24-months prior to incident diagnosis of pneumonia. Robust Poisson regression will model impact of musculoskeletal pain on need for hospitalisation, readmission, and short-term mortality. Negative binomial regression will be used to determine differences in hospital length of stay. Flexible parametric survival models will be used for time to mortality after 30 days to 1 year. We will assess if impact varies by time of most recent musculoskeletal consultation or pain severity (proxy measures of musculoskeletal referral, analgesia prescription). We will also determine if inequalities exist in these relationships by socioeconomic characteristics (age, ethnicity, deprivation, geographical region), and if relationships differ by type of painful musculoskeletal condition. Our findings will allow assessment of the potential for existing evidence-based management of musculoskeletal pain and associated disability to be targeted at patients to improve outcomes following a diagnosis of pneumonia.

Health Outcomes to be Measured

i) Hospitalisation for initial episode of pneumonia
ii) Length of stay in hospital for initial episode based on admission and discharge dates recorded in HES
iii) Readmission to hospital within 30 days of discharge for pneumonia
iv) Readmission to hospital within 30 days of discharge for any reason
v) (time to) Mortality based on recorded information in linked ONS data within 30 days of index date of diagnosis and up to 1 year after index date
vi) Cumulative health care use and costs over 1 year after index date. Primary care data will include number, type and length of consultations with each health care professional, prescriptions, tests and investigations. Secondary care utilisation includes referral, type of admission, length of stay, diagnosis, and procedures undertaken.


Kelvin Jordan - Chief Investigator - Keele University
Kayleigh Mason - Corresponding Applicant - Keele University
Alyson Huntley - Collaborator - University of Bristol
Christian Mallen - Collaborator - Keele University
Felix Achana - Collaborator - University of Oxford
James Bailey - Collaborator - Keele University
John Edwards - Collaborator - Keele University
Mamas Mamas - Collaborator - Keele University
Martin Frisher - Collaborator - Keele University
May Ee Png - Collaborator - University of Oxford
Michelle Marshall - Collaborator - Keele University
Neil Heron - Collaborator - Keele University
Simon White - Collaborator - Keele University
stephen tatton - Collaborator - Keele University


HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation