Pneumonia incidence, hospitalizations and mortality before and during the COVID-19 pandemic in Peru: An observational study

Background Pneumonia is a leading cause of morbidity and mortality in children and older adults. COVID-19 related disruptions in healthcare and surveillance may have altered incidence, hospitalizations, and deaths. We assessed pneumonia incidence, hospitalizations, and mortality rates in children under five and adults older than 60 years in Peru during the COVID-19 pandemic (2020–22) versus the pre-pandemic period (2015–19). Methods We conducted a retrospective population-based time series study using nationwide surveillance system data on reported pneumonia cases, hospitalizations, and deaths in Peru from 2015 to 2022. Age- and region-specific incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals were estimated for pneumonia cases, hospitalizations, and deaths by comparing the pandemic period (2020–22) with the pooled pre-pandemic period (2015–19). Results Between January 1, 2015, and December 31, 2022, 170,558 pneumonia cases were reported among children younger than 5 years and 163,938 among adults aged >60 years in Peru. During the same period, 56,680 and 68,476 hospitalizations and 1,563 and 16,485 deaths occurred in these age groups, respectively. Compared with the pre-pandemic period (2015–2019), pneumonia incidence among children younger than 5 years declined markedly during the pandemic, decreasing by 71% in 2020 (IRR, 0.29; 95% CI, 0.28–0.30), 63% in 2021 (IRR, 0.37; 95% CI, 0.36–0.38), and 12% in 2022 (IRR, 0.88; 95% CI, 0.87–0.90). Hospitalizations and mortality in this group also decreased. In contrast, adults aged >60 years experienced increased hospitalization and mortality rates, particularly in 2021 (hospitalizations: IRR, 2.04; 95% CI, 1.97–2.09; mortality: IRR, 4.28; 95% CI, 4.01–4.57). Substantial regional heterogeneity was observed across Peru. Conclusions During the COVID-19 pandemic, pneumonia epidemiology in Peru showed contrasting patterns by age, with sustained declines in incidence, hospitalizations, and mortality among children younger than 5 years, but increased hospitalizations and mortality among adults aged >60 years, underscoring the need to strengthen surveillance, access to timely care, and vaccination programs.