Incidence of community acquired lower respiratory tract disease in Bristol, UK following the emergence of SARS-CoV-2: a prospective cohort study 2020-2024
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Surveillance of acute lower respiratory tract disease (aLRTD) is fundamental for understanding population health burden and healthcare needs. COVID-19 altered the epidemiology of respiratory infections, but post-pandemic aLRTD incidence and severity remain underexplored in the UK. We conducted a prospective cohort study of adults (≥18 years) admitted to two Bristol hospitals (August 2020–July 2024) with symptoms or a diagnosis of pneumonia, non-pneumonic lower respiratory tract infection (NP-LRTI), or no evidence of LRTI. Of 457,112 hospitalizations, 44,792 (9.8%) were due to aLRTD: 48.2% pneumonia, 35.2% NP-LRTI, and 16.7% no LRTI. Incidence peaked in 2021-22 (14.4/1,000 person-years) due to COVID-19 before stabilizing around 13.6. SARS-CoV-2 pneumonia declined; non-COVID pneumonia remained stable. Mortality risk was lower for NP-LRTI (HR 0.32) and no LRTI (HR 0.43) compared to pneumonia. Older age and comorbidities increased mortality. Non-COVID infections persisted despite interventions, emphasizing the need for surveillance and vaccination in public health planning.
