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 language | English (US) |
|---|---|
| Pages (from-to) | 1008-1017 |
| Number of pages | 10 |
| Journal | CHEST |
| Volume | 144 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2013 |
Funding
Funding/Support: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by the National Heart, Lung, and Blood Institute (NHLBI) [ Contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 ]. This research was supported by NHLBI [ Contracts HHSN268201200036C, HHSN268200800007C, N01-HC-55222, N01-HC-85079, N01-HC-85080, N01-HC-85081, N01-HC-85082, N01-HC-85083, H01-HC-85086 and Grant HL080295 ], with additional contribution from National Institute of Neurological Disorders and Stroke. Additional support was provided by the National Institute on Aging (NIA) [ Grant AG-023629 ]. A full list of principal Cardiovascular Health Study investigators and institutions can be found at CHS-NHLBI.org . The Health, Aging, and Body Composition Study is supported by NIA [Contracts N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106, R01-AG028050, and R01-NR012459]. This study was in part funded by National Institutes of Health [Grant K23GM083215 to Dr Yende] and Intramural Research Programs of the National Institute of Environmental Health Sciences and NIA.
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine