Pleural effusion rate high in China; causes differ by age, smoking status
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In China, of the number of adults with pleural effusions is high, and causes appear to differ by age and smoking status, according to new findings published in JAMA Network Open.
“More than 50 causes of pleural effusion are recognized. An estimated 1.5 million patients in the U.S. experience [pleural effusion] each year, with most cases caused by congestive heart failure, pneumonia and cancer. ... However, studies on the epidemiology of [pleural effusions] in the Chinese population are scant,” Panwen Tian, MD, from the department of respiratory and critical care medicine at the Lung Cancer Treatment Center at West China Hospital at Sichuan University in Chengdu, China, and colleagues wrote.
Tian and colleagues conducted a multicenter, cross-sectional study that involved a nationally representative sample of 24,711 patients with pleural effusions (mean age, 61.6 years; 62.9% men) from 56 general hospitals in 50 municipalities in China in 2018. Ultrasonography or CT was used to confirm pleural effusion.
The estimated prevalence of pleural effusion was 4,684 per 1 million Chinese adults.
The most common causes of pleural effusion were parapneumonic pleural effusion and empyema (25.1%), malignant neoplasm (23.7%) and tuberculosis (12.3%). TB was the most common cause of pleural effusions among patients aged 18 to 39 years, (4.3%), malignant neoplasm was the most common cause among patients aged 60 to 79 years (13%), and parapneumonic pleural effusion and empyema was the most common cause among patients aged 40 to 59 years (7.1%) and patients who were aged at least 80 years (5.5%).
Compared with nonsmokers, current smokers were more likely to have malignant pleural effusions (28.3% vs. 33.1%; P < .001) and TB (14.9% vs. 15.7%; P = .03).
In addition, researchers observed a median hospitalization cost of $2,401.40 among the patients with pleural effusion, which they noted was similar to costs per patient for COPD ($1,964 to $3,449 per patient). These hospitalization costs represented 33% to 40% of the mean household income in China, thus presenting pleural effusion health care as a significant burden of cost for both individual and social health insurance, according to the researchers.
“Policymakers and health care professionals should address this concern by considering age and smoking factors when developing preventions and treatments for patients with pleural effusions,” the researchers wrote.