Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts

Sachin Yende*, Karina Alvarez, Laura Loehr, Aaron R. Folsom, Anne B. Newman, Lisa A. Weissfeld, Richard G Wunderink, Stephen B. Kritchevsky, Kenneth J. Mukamal, Stephanie J. London, Tamara B. Harris, Doug C. Bauer, Derek C. Angus

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background: Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals. Methods: This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization. Results: The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15%). The 30-day and 1-year mortality were 16.5% and 31.5%. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38% of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5% and 25.7% in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV 1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC 5 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance. Conclusions: Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.

Original languageEnglish (US)
Pages (from-to)1008-1017
Number of pages10
JournalChest
Volume144
Issue number3
DOIs
StatePublished - Jan 1 2013

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Independent Living
Biological Factors
Pneumonia
Epidemiology
Cohort Studies
Area Under Curve
Mortality
Incidence
Young Adult
Hospitalization
Lung
Spirometry
C-Reactive Protein
Calibration
Comorbidity
Interleukin-6
Smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Yende, S., Alvarez, K., Loehr, L., Folsom, A. R., Newman, A. B., Weissfeld, L. A., ... Angus, D. C. (2013). Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts. Chest, 144(3), 1008-1017. https://doi.org/10.1378/chest.12-2818
Yende, Sachin ; Alvarez, Karina ; Loehr, Laura ; Folsom, Aaron R. ; Newman, Anne B. ; Weissfeld, Lisa A. ; Wunderink, Richard G ; Kritchevsky, Stephen B. ; Mukamal, Kenneth J. ; London, Stephanie J. ; Harris, Tamara B. ; Bauer, Doug C. ; Angus, Derek C. / Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts. In: Chest. 2013 ; Vol. 144, No. 3. pp. 1008-1017.
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abstract = "Background: Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals. Methods: This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization. Results: The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15{\%}). The 30-day and 1-year mortality were 16.5{\%} and 31.5{\%}. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38{\%} of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5{\%} and 25.7{\%} in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV 1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC 5 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance. Conclusions: Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.",
author = "Sachin Yende and Karina Alvarez and Laura Loehr and Folsom, {Aaron R.} and Newman, {Anne B.} and Weissfeld, {Lisa A.} and Wunderink, {Richard G} and Kritchevsky, {Stephen B.} and Mukamal, {Kenneth J.} and London, {Stephanie J.} and Harris, {Tamara B.} and Bauer, {Doug C.} and Angus, {Derek C.}",
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Yende, S, Alvarez, K, Loehr, L, Folsom, AR, Newman, AB, Weissfeld, LA, Wunderink, RG, Kritchevsky, SB, Mukamal, KJ, London, SJ, Harris, TB, Bauer, DC & Angus, DC 2013, 'Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts', Chest, vol. 144, no. 3, pp. 1008-1017. https://doi.org/10.1378/chest.12-2818

Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts. / Yende, Sachin; Alvarez, Karina; Loehr, Laura; Folsom, Aaron R.; Newman, Anne B.; Weissfeld, Lisa A.; Wunderink, Richard G; Kritchevsky, Stephen B.; Mukamal, Kenneth J.; London, Stephanie J.; Harris, Tamara B.; Bauer, Doug C.; Angus, Derek C.

In: Chest, Vol. 144, No. 3, 01.01.2013, p. 1008-1017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans analysis of three cohorts

AU - Yende, Sachin

AU - Alvarez, Karina

AU - Loehr, Laura

AU - Folsom, Aaron R.

AU - Newman, Anne B.

AU - Weissfeld, Lisa A.

AU - Wunderink, Richard G

AU - Kritchevsky, Stephen B.

AU - Mukamal, Kenneth J.

AU - London, Stephanie J.

AU - Harris, Tamara B.

AU - Bauer, Doug C.

AU - Angus, Derek C.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals. Methods: This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization. Results: The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15%). The 30-day and 1-year mortality were 16.5% and 31.5%. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38% of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5% and 25.7% in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV 1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC 5 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance. Conclusions: Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.

AB - Background: Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals. Methods: This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization. Results: The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15%). The 30-day and 1-year mortality were 16.5% and 31.5%. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38% of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5% and 25.7% in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV 1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC 5 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance. Conclusions: Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.

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