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Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans: analysis of three cohorts.
Tuesday,2013-12-31 13:38 America/Los_Angeles — poolea2
| Title | Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans: analysis of three cohorts. |
| Publication Type | Journal Article |
| Year of Publication | 2013 |
| Authors | 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 |
| Corporate/Institutional Authors | Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, and the Health, Aging, and Body Composition Study |
| Journal | Chest |
| Volume | 144 |
| Issue | 3 |
| Pagination | 1008-1017 |
| Date Published | 2013 Sep |
| ISSN | 1931-3543 |
| Keywords | Age Factors, Aged, Aged, 80 and over, Community-Acquired Infections, Comorbidity, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Middle Aged, Pneumonia, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Survival Rate, Time Factors |
| Abstract | <p><b>BACKGROUND: </b>Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1378/chest.12-2818 |
| Alternate Journal | Chest |
| PubMed ID | 23744106 |
| PubMed Central ID | PMC3760741 |
| Grant List | N01HC55020 / HL / NHLBI NIH HHS / United States R01-AG028050 / AG / NIA NIH HHS / United States N01-AG-6-2101 / AG / NIA NIH HHS / United States N01HC55018 / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-55022 / HC / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-AG-6-2103 / AG / NIA NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States N01-HC-55016 / HC / NHLBI NIH HHS / United States R01-NR012459 / NR / NINR NIH HHS / United States K23 GM083215 / GM / NIGMS NIH HHS / United States N01HC55022 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-55021 / HC / NHLBI NIH HHS / United States N01HC55015 / HL / NHLBI NIH HHS / United States R01 NR012459 / NR / NINR NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States / / Intramural NIH HHS / United States N01-HC-55019 / HC / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States N01-HC-55015 / HC / NHLBI NIH HHS / United States H01-HC-85086 / HC / NHLBI NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States K23GM083215 / GM / NIGMS NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-55020 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01HC55016 / HL / NHLBI NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01 AG028050 / AG / NIA NIH HHS / United States N01-AG-6-2106 / AG / NIA NIH HHS / United States HHSN268200800007C / / PHS HHS / United States N01HC55019 / HL / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States HHSN268201200036C / / PHS HHS / United States HL080295 / HL / NHLBI NIH HHS / United States AG-023629 / AG / NIA NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01-HC-55018 / HC / NHLBI NIH HHS / United States N01HC55021 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States R56 AG023629 / AG / NIA NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States |