03667nas a2200529 4500008004100000022001400041245014600055210006900201260001300270300001400283490000800297520205900305653001602364653000902380653002202389653003402411653001602445653001102461653002202472653002002494653001102514653001402525653000902539653001602548653001402564653001402578653002402592653002002616653001702636653001802653653001702671100001802688700002002706700001702726700002102743700002002764700002302784700002602807700002802833700002402861700002502885700002202910700001902932700002002951710013002971856003603101 2013 eng d a1931-354300aEpidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans: analysis of three cohorts.0 aEpidemiology and longterm clinical and biologic risk factors for c2013 Sep a1008-10170 v1443 a
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 FEV1 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 = 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.
10aAge Factors10aAged10aAged, 80 and over10aCommunity-Acquired Infections10aComorbidity10aFemale10aFollow-Up Studies10aHospitalization10aHumans10aIncidence10aMale10aMiddle Aged10aPneumonia10aPrognosis10aProspective Studies10aRisk Assessment10aRisk Factors10aSurvival Rate10aTime Factors1 aYende, Sachin1 aAlvarez, Karina1 aLoehr, Laura1 aFolsom, Aaron, R1 aNewman, Anne, B1 aWeissfeld, Lisa, A1 aWunderink, Richard, G1 aKritchevsky, Stephen, B1 aMukamal, Kenneth, J1 aLondon, Stephanie, J1 aHarris, Tamara, B1 aBauer, Doug, C1 aAngus, Derek, C1 aAtherosclerosis Risk in Communities Study, the Cardiovascular Health Study, and the Health, Aging, and Body Composition Study uhttps://chs-nhlbi.org/node/6193