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Prognosis After Community-Acquired Pneumonia in the Elderly
A Population-Based 12-Year Follow-up Study
Irma Koivula, MD;
Marja Stén, MD;
Pirjo Helena Mäkelä, MD, PhD
Arch Intern Med. 1999;159:1550-1555.
Background Only a few studies have investigated the long-term effects of community-acquired pneumonia (CAP). These studies have focused on cases treated in the hospital, and, to our knowledge, no long-term survival studies that include all cases of CAP are available.
Methods A prospective observational study on the survival rates in a population-based cohort of elderly inhabitants aged 60 years or older at baseline in 1 township in eastern Finland in 1983. A total of 4167 (99% of the total elderly population), 122 of whom survived CAP during a prospective pneumonia surveillance period from 1983 to 1985, were followed up for mortality from 1983 to 1994 for a median of 9.2 years. The relative risk (RR) of death in patients who survived CAP was compared with that in elderly inhabitants without CAP by Cox multivariate regression analysis. Data on causes of death were obtained from a central register based on death certificates.
Results The long-term survival rate was significantly lower in persons who had survived CAP or pneumococcal CAP (PCAP) than in the rest of the study population. The RR of pneumonia-related mortality was 2.1 (95% confidence interval [CI], 1.3-3.4; P=.004) in all patients with CAP and 2.8 (95% CI, 1.5-5.3; P=.001) in patients with PCAP. The respective numbers for total mortality were 1.5 (95% CI, 1.2-1.9; P=.001) in all patients with CAP and 1.6 (95% CI, 1.1-2.2; P=.01) in those with PCAP. Also the risk of cardiovascular mortality was increased in persons with CAP (RR, 1.4; 95% CI, 1.0-1.9; P=.02) and in those with PCAP (RR, 1.6; 95% CI, 1.0-2.4; P=.04).
Conclusions The present results indicate that elderly patients treated for CAP are at high risk of subsequent mortality for several years. Based on the high incidence and negative long-term effects of pneumonia, it can be concluded that there is a clear need for prevention, eg, by influenza and pneumococcal immunization.
From the Department of Medicine, Division of Infectious Diseases, Kuopio University Hospital, Kuopio (Dr Koivula), the Health Center of Varkaus, Varkaus (Dr Stén), and the National Public Health Institute, Helsinki (Dr Mäkelä), Finland.
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