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Pleural effusion epidemiology and demographics

Introduction

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.

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.