Objective: Pneumonia and acute lower respiratory infections are a major pro
blem in the United States and worldwide. As one of the largest health care
organizations in the United States, the Department of Veterans Affairs is a
n Ideal location for an epidemiologic review of pneumonia over an extended
period of time. Methods: Data for this study were retrieved from the Depart
ment of Veterans Affairs Austin Automation Center, the central repository f
or patient data in the Veterans Health Administration (VHA). In addition, s
pecific data regarding penicillin-resistant Streptococcus pneumoniae in VHA
facilities were obtained from an annual electronic nationwide census. Resu
lts: The case rate of pneumonias as a discharge diagnosis increased during
the 6-year period. For the diagnosis group of bronchopneumonia and pneumoni
a with organism unspecified, the largest subset examined, total numbers and
rates for this specific diagnosis increased during the study period. When
fiscal year (FY)91 and FY96 were compared, rates increased for three diagno
ses: overall pneumonia, pneumonia in infectious diseases classified elsewhe
re, and pneumococcal pneumonia. Decreases in rates occurred between FY91 an
d FY96 for pneumonia caused by other specified organisms and other bacteria
l pneumonia. The total number of discharges from VHA facilities decreased d
uring the 6-year period. Conclusions: The numbers of episodes of bronchopne
umonia and pneumonia with organism unspecified, the largest pneumonia subse
t, increased during the 6-year period to greater than 27,000 cases. As the
number of total discharges from the VHA decreased, the combination of incre
asing actual numbers and decreasing discharges yielded increased rates for
overall pneumonia and certain subsets. These data should be useful in devel
oping aggressive preventive strategies.