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Pleural effusion epidemiology and demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]; Nate Michalak, B.A.

Overview

Overview

In the United States, up to one million patients develop parapneumonic effusions annually, and approximately 100,000 patients undergo pleurodesis for recurrent pleural effusions per year.[1] Pleural effusion is reported to have an incidence of 0.32% in a study among the general population in central Bohemia. Congestive heart failure accounts for nearly 50% of cases, with malignancy, pneumonia and pulmonary emboli as the next three leading causes.[2] However, the distribution of causes is largely dependent on the population being studied. For example, the incidence of pleural effusion among ICU patients is estimated to be 22.19 ± 17%,[3] whereas the prevalence of tuberculous pleural effusion remains steady with respect to the total number of TB cases (14.3%-19.3%).[4] The incidence of parapneumonic effusions is constantly increasing, although, the microbial epidemiology of these effusions differs from pneumonia with a higher prevalence of anaerobic bacteria.[5] The incidence of pediatric empyema increased from 1 per 100,000 children aged 0 to 14 years in 1998 to 10 per 100,000 in 2012, with a peak incidence of 13 per 100,000 in 2009[6] with Staphylococcus aureus as the most frequent cause followed by S. pneumoniae. The age predominace of pleural effusion varies depending on the underlying cause. Greater than 60% of tuberculous pleural effusion commonly affects individuals between 15-44 years.[4] Pleural effusions are the most common thoracic involvement findings in patients with POEMS syndrome, affecting more than 40% of cases with median age at the time of diagnosis of POEMS syndrome as 45.1 years.[7] HIV infection,[4] pleural empyema, and complicated parapneumonic effusion is mostly seen in middle-aged patients (53 ± 17 years).[8] Males are more commonly affected with tuberculous pleural effusion than females. The male to female ratio is approximately 3:2.[4] Males are more commonly affected with pleural empyema and complicated parapneumonic pleural effusion than females. The male to female ratio is approximately 2:1.[8] There is no racial predilection to pleural effusion. Development of tuberculous pleural effusion is common on endemic developing countries with TB infection.[4]

Epidemiology and Demographics

Epidemiology and Demographics

Incidence and Prevalence

  • In the United States, up to one million patients develop parapneumonic effusions annually, and approximately 100,000 patients undergo pleurodesis for recurrent pleural effusions per year.[1] Pleural effusion is reported to have an incidence of 0.32% in a study among the general population in central Bohemia. Congestive heart failure accounts for nearly 50% of cases, with malignancy, pneumonia and pulmonary emboli as the next three leading causes.[2] However, the distribution of causes is largely dependent on the population studied.
  • The incidence of pleural effusion among ICU patients is estimated to be 22.19 ± 17%.[3]
  • Tuberculosis is one of the most frequent causes of pleural effusion. Although, the incidence has steadily declined in some countries (4.8 cases/100,000 population), the prevalence of tuberculous pleural effusion remains steady with respect to the total number of TB cases (14.3%-19.3%).[4]
  • The incidence of pediatric empyema increased from 1 per 100,000 children aged 0 to 14 years in 1998 to 10 per 100,000 in 2012, with a peak incidence of 13 per 100,000 in 2009[6] with Staphylococcus aureus as the most frequent cause followed by S. pneumoniae.

Age

The age predominace of pleural effusion varies depending on the underlying cause as shown below:

  • Greater than 60% of tuberculous pleural effusion commonly affects individuals between 15-44 years.[4]
  • Pleural effusions are the most common thoracic involvement findings in patients with POEMS syndrome, affecting more than 40% of cases with median age at the time of diagnosis of POEMS syndrome as 45.1 years.[7]

Gender

  • Males are more commonly affected with tuberculous pleural effusion than females. The male to female ratio is approximately 3:2.[4]
  • Males are more commonly affected with pleural empyema and complicated parapneumonic pleural effusion than females. The male to female ratio is approximately 2:1[8]

Race

  • There is no racial predilection to pleural effusion.

Developed/developing countries

  • Development of tuberculous pleural effusion is common on endemic developing countries with TB infection.[4]
References

References

  1. ↑ 1.0 1.1 Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.
  2. ↑ 2.0 2.1 Marel M, Zrůstová M, Stasný B, Light RW (1993). “The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia”. Chest. 104 (5): 1486–9. PMID 8222812. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Azoulay E, Fartoukh M, Similowski T, Galliot R, Soufir L, Le Gall JR; et al. (2001). “Routine exploratory thoracentesis in ICU patients with pleural effusions: results of a French questionnaire study”. J Crit Care. 16 (3): 98–101. doi:10.1053/jcrc.2001.28784. PMID 11689765.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 Ferreiro L, San José E, Valdés L (2014). “Tuberculous pleural effusion”. Arch Bronconeumol. 50 (10): 435–43. doi:10.1016/j.arbres.2013.07.006. PMID 24721286.
  5. ↑ 5.0 5.1 Letheulle J, Kerjouan M, Bénézit F, De Latour B, Tattevin P, Piau C; et al. (2015). “[Parapneumonic pleural effusions: Epidemiology, diagnosis, classification and management]”. Rev Mal Respir. 32 (4): 344–57. doi:10.1016/j.rmr.2014.12.001. PMID 25595878.
  6. ↑ 6.0 6.1 Mahon C, Walker W, Drage A, Best E (2016). “Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children”. J Paediatr Child Health. 52 (6): 662–8. doi:10.1111/jpc.13172. PMID 27059295.
  7. ↑ 7.0 7.1 Cui RT, Yu SY, Huang XS, Zhang JT, Tian CL, Dou LP; et al. (2015). “Incidence and risk factors of pleural effusions in patients with POEMS syndrome”. Hematol Oncol. 33 (2): 80–4. doi:10.1002/hon.2135. PMID 24519469.
  8. ↑ 8.0 8.1 8.2 8.3 Zablockis R, Petruskeviciene R, Nargela RV (2010). “[Causes and risk factors of pleural empyema and complicated parapneumonic pleural effusion]”. Medicina (Kaunas). 46 (2): 113–9. PMID 20440084.

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