Risk factors for pneumonia in the elderly

doi:10.1016/0002-9343(94)90060-4

The American Journal of Medicine

Volume 96, Issue 4, April 1994, Pages 313-320

https://doi.org/10.1016/0002-9343(94)90060-4 Get rights and content

Abstract

purpose: To investigate the prevalence of certain chronic conditions among the elderly and to estimate the relative risk for pneumonia associated with each condition.

patients and methods: Medical records of all inhabitants aged 60 years or more (4,175 persons) in one township (population 24,716) in Finland were reviewed, seeking 15 chronic conditions. Which patients had pneumonia in the same population was prospectively ascertained over a period of 3 years (185 patients).

results: Hypertension was the most frequent chronic condition (36.4%) in the study population. Other common conditions were heart disease (23.7%, with chronic compensated heart failure in 96.3% of these), other cardiovascular disease (13.1%), and diabetes (13.1%). The prevalence of any other condition was less than 5%. The following conditions were significantly more common among pneumonia patients than among control subjects: heart disease (38.4% versus 23.0%), lung disease (13.0% versus 3.8%), bronchial asthma (11.9% versus 3.1%), immunosuppressive therapy (2.7% versus 0.8%), alcoholism (2.2% versus 0.3%), and institutionalization (8.6% versus 3.9%). By multivariate logistic regression analysis, independent risk factors for pneumonia were alcoholism (relative risk [RR]= 9.0, confidence interval [Cl] = 5.1 to 16.2), bronchial asthma (RR = 4.2, Cl = 3.3 to 5.4), immunosuppressive therapy (RR = 3.1, Cl = 1.9 to 5.1), lung disease (RR = 3.0, Cl = 2.3 to 3.9), heart disease (RR = 1.9, Cl = 1.7 to 2.3), institutionalization (RR = 1.8, Cl = 1.4 to 2.4), and age (70 years or more versus 60 to 69 years; RR = 1.5, Cl = 1.3 to 1.7). One third of the study population and 57% of the pneumonia patients had one or more of these risk factors. Diabetes, chronic pyelonephritis, and malignancies of sites other than the lungs were not associated with increased risk for pneumonia.

conclusion: We found which elderly persons have an increased risk for pneumonia. Although the highest relative risk was associated with alcoholism, that condition was rare in this elderly population. Chronic obstructive lung diseases were more common and were also associated with a high relative risk. Heart disease had the highest public health impact because it was very common among the elderly and increased the risk of contracting pneumonia almost twofold; it also increased the risk of pneumonia-related death. These population-based data confirm and extend previous findings derived from selected patient groups and are useful for designing cost-effective pneumonia prevention programs.

References (39)

M Levy et al.
Community-acquired pneumonia
MA Woodhead et al.
Prospective study of the aetiology and outcome of pneumonia in the community
Lancet.
(1987)
GA Harkness et al.
Risk factors for nosocomial pneumonia in the elderly
Am J Med.
(1990)
LC Hanson et al.
Risk factors for nosocomial pneumonia in the elderly
Am J Med.
(1992)
H Forrester et al.
Inefficacy of pneumococcal vaccine in a high-risk population
Am J Med.
(1987)
RA Garibaldi et al.
Risk factors for postoperative pneumonia
Am J Med.
(1981)
KP Bouter et al.
Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976–1979 in The Netherlands
Diabetes Res Clin Pract.
(1991)
Central Statistical Office of Finland
Statistical Year Book of Finland 1985–1988
AZ LaCroix et al.
Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors and nutritional status
Pub Health Rep.
(1989)
RJ Sullivan et al.
Adult pneumonia in a general hospital

GJ Dorff et al.

Etiologies and characteristic features of pneumonias in a municipal hospital

Am J Med Sci.

(1973)

RJ White et al.

Causes of pneumonia presenting to a district general hospital

Thorax.

(1981)

MA Mufson et al.

Pneumococcal disease in a medium-sized community in the United States

JAMA

(1982)

JT Mcfarlane et al.

Hospital study of adult community-acquired pneumonia

Lancet

(1982)

E Berntsson et al.

Etiology of community-acquired pneumonia in patients requiring hospitalization

Eur J Clin Microbiol Infect Dis.

(1985)

TJ Marrie et al.

Community-acquired pneumonia requiring hospitalization: 5-year prospective study

Rev Infect Dis.

(1989)

E Berntsson et al.

Etiology of community-acquired pneumonia in outpatients

Eur J Clin Microbiol Infect Dis.

(1986)

British Thoracic Society

Community-acquired pneumonia in adults in British hospitals in 1982–1983: A survey of aetiology, mortality, prognostic factors and outcome

Q J Med.

(1987)

V Ausina et al.

Prospective study on the etiology of community-acquired pneumonia in childern and adults in Spain

Eur J Clin Microbiol Infect Dis.

(1988)

Cited by (310)

CheXMed: A multimodal learning algorithm for pneumonia detection in the elderly
2024, Information Sciences
Pneumonia can be a deadly illness for particular populations, one of which is older adults. While studies have successfully trained artificial intelligent assisted diagnostic tools to detect pneumonia using chest X-ray images, they were targeted to the general population without stratification on age groups. This study (a) investigated the performance disparities between geriatric and younger patients when using chest X-ray images to detect pneumonia, and (b) developed and tested a multimodal model called CheXMed that incorporates clinical notes together with image data to improve pneumonia detection performance for older people. Accuracy, precision, recall, and F1-score were used for model performance evaluation. CheXMed outperforms baseline models on all evaluation metrics. The accuracy, precision, recall, and F1-score are 0.746, 0.746, 0.740, 0.743 for CheXMed, 0.645, 0.680, 0.535, 0.599 for CheXNet, 0.623, 0.655, 0.521, 0.580 for DenseNet121, and 0.610, 0.617, 0.543, 0.577 for ResNet18.
Long-term Exposure to Ambient Air Pollutants and Increased Risk of Pneumonia in the UK Biobank
2023, Chest
Short-term exposure to air pollution has been linked to pneumonia risk. However, evidence on the long-term effects of air pollution on pneumonia morbidity is scarce and inconsistent. We investigated the associations of long-term air pollutant exposure with pneumonia and explored the potential interactions with smoking.
Is long-term exposure to ambient air pollution associated with the risk of pneumonia, and does smoking modify the associations?
We analyzed data in 445,473 participants without pneumonia within 1 year before baseline from the UK Biobank. Annual average concentrations of particulate matter (particulate matter with a diameter < 2.5 μm [PM_2.5] and particulate matter with a diameter < 10 μm [PM₁₀]), nitrogen dioxide (NO₂), and nitrogen oxides (NO_x) were estimated using land-use regression models. Cox proportional hazards models were used to assess the associations between air pollutants and pneumonia incidence. Potential interactions between air pollution and smoking were examined on both additive and multiplicative scales.
The hazard ratios of pneumonia for each interquartile range increase in PM_2.5, PM₁₀, NO₂, and NO_x concentrations were 1.06 (95% CI, 1.04-1.08), 1.10 (95% CI, 1.08-1.12), 1.12 (95% CI, 1.10-1.15), and 1.06 (95% CI, 1.04-1.07), respectively. There were significant additive and multiplicative interactions between air pollution and smoking. Compared with individuals who had never smoked with low air pollution exposure, individuals who had ever smoked with high air pollution exposure had the highest pneumonia risk (PM_2.5: hazard ratio [HR], 1.78; 95% CI, 1.67-1.90; PM₁₀: HR, 1.94; 95% CI, 1.82-2.06; NO₂: HR, 2.06; 95% CI, 1.93-2.21; NO_x: HR, 1.88; 95% CI, 1.76-2.00). The associations between air pollutants and pneumonia risk persisted in participants exposed to air pollutants concentrations meeting the European Union limits.
Long-term exposure to air pollutants was associated with an increased risk of pneumonia, especially in individuals who smoke.
Epidemiology of pneumonia in hospitalized adults ≥18 years old in four districts of Ulaanbaatar, Mongolia, 2015–2019
2023, The Lancet Regional Health - Western Pacific
Community-acquired pneumonia is a leading cause of morbidity and mortality among children and adults worldwide. Adult pneumonia surveillance remains limited in many low- and middle-income settings, resulting in the disease burden being largely unknown.
A retrospective cohort study was conducted by reviewing medical charts for respiratory admissions at four district hospitals in Ulaanbaatar during January 2015–February 2019. Characteristics of community-acquired pneumonia cases were summarized by disease severity and age. To explore factors associated with severe pneumonia, we ran univariable and age-adjusted logistic regression models. Incidence rates were calculated using population denominators.
In total, 4290 respiratory admissions met the case definition for clinical pneumonia, including 430 admissions of severe pneumonia. The highest proportion of severe pneumonia admissions occurred in adults >65 years (37.4%). After adjusting for age, there were increased odds of severe pneumonia in males (adjusted odds ratio [aOR]: 1.63; 95% confidence interval [CI]: 1.33-2.00) and those with ≥1 underlying medical condition (aOR: 1.46; 95% CI: 1.14-1.87). The incidence of hospitalized pneumonia in adults ≥18 years increased from 13.49 (95% CI: 12.58-14.44) in 2015 to 17.65 (95% CI: 16.63-18.71) in 2018 per 10,000 population. The incidence of severe pneumonia was highest in adults >65 years, ranging from 9.29 (95% CI: 6.17-13.43) in 2015 to 12.69 (95% CI: 9.22-17.04) in 2018 per 10,000 population.
Vaccination and other strategies to reduce the risk of pneumonia, particularly among older adults and those with underlying medical conditions, should be prioritized.
Pfizer clinical research collaboration agreement (contract number: WI236621).
Peripheral Artery Disease and Subsequent Risk of Infectious Disease in Older Individuals: The ARIC Study
2022, Mayo Clinic Proceedings
To quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection.
Among 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease.
During the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7.
Peripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases.
Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort
2022, Revista Espanola de Geriatria y Gerontologia
The geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19.
A prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality.
305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82–91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p < 0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%).
The incidence of cardiovascular complications in geriatric patients is high and is associated with a longer hospital stay. CHF was the most frequent event, followed by AF.
La población geriátrica es especialmente vulnerable a la enfermedad por coronavirus (COVID-19) y sus posibles complicaciones. Nos propusimos analizar la incidencia de complicaciones cardiológicas en una población anciana hospitalizada por COVID-19.
Estudio longitudinal observacional prospectivo que incluyó a pacientes ≥ 75 años con diagnóstico de COVID-19 ingresados en el Servicio de Geriatría de marzo a mayo de 2020. Se recogieron variables epidemiológicas, geriátricas, clínicas y de laboratorio. Se documentaron eventos cardiovasculares, que incluyen fibrilación auricular (FA) de novo, síndrome coronario agudo, insuficiencia cardíaca congestiva, embolia pulmonar y muerte intrahospitalaria. Se realizó un seguimiento a los 12 meses, mediante entrevista telefónica y accediendo a la historia clínica electrónica, recogiendo eventos cardíacos y mortalidad.
Se incluyeron 305 pacientes; 190 (62,3%) eran mujeres, con una mediana de edad de 87 años (rango intercuartílico: 82-91). Más de la mitad de los pacientes tenían antecedentes de enfermedad cardíaca, siendo la FA la más frecuente y afectando a 85 (27,9%) pacientes. Durante la hospitalización fallecieron 112 (36,7%) pacientes. Ochenta y nueve (29,2%) pacientes presentaron complicaciones cardíacas. La insuficiencia cardíaca congestiva aguda fue la más prevalente (46; 15,1%), seguida de la FA de nueva aparición (20; 6,5%), la embolia pulmonar (17; 5,6%) y el síndrome coronario agudo (5; 1,6%). Los pacientes con complicaciones cardíacas tuvieron una estancia hospitalaria más prolongada (p < 0,001). Durante el seguimiento fallecieron 29 pacientes (15,1%) y 40 (20,8%) presentaron un evento cardiovascular, siendo la insuficiencia cardíaca congestiva la complicación más prevalente (16,7%).
La incidencia de complicaciones cardiovasculares en pacientes geriátricos es alta y se asocia a una mayor estancia hospitalaria. La insuficiencia cardíaca congestiva fue el evento más frecuente, seguida de la FA.
Genetic Susceptibility to Pneumonia: A GWAS Meta-Analysis between the UK Biobank and FinnGen
2021, Twin Research and Human Genetics

View all citing articles on Scopus

^☆: This study was supported by the Paulo Foundation, the Päivikki and Sakari Sohlberg Foundation, the Tampere Tuberculosis Foundation, the Väinö and Laina Kivi Foundation, and the Orion Corporation Research Foundation.

View full text

Risk factors for pneumonia in the elderly☆

Abstract

Lancet.

Am J Med.

Am J Med.

Am J Med.

Am J Med.

Diabetes Res Clin Pract.

Statistical Year Book of Finland 1985–1988

Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors and nutritional status

Pub Health Rep.

Adult pneumonia in a general hospital

Etiologies and characteristic features of pneumonias in a municipal hospital

Am J Med Sci.

Causes of pneumonia presenting to a district general hospital

Thorax.

Pneumococcal disease in a medium-sized community in the United States

JAMA

Hospital study of adult community-acquired pneumonia

Lancet

Etiology of community-acquired pneumonia in patients requiring hospitalization

Eur J Clin Microbiol Infect Dis.

Community-acquired pneumonia requiring hospitalization: 5-year prospective study

Rev Infect Dis.

Etiology of community-acquired pneumonia in outpatients

Eur J Clin Microbiol Infect Dis.

Community-acquired pneumonia in adults in British hospitals in 1982–1983: A survey of aetiology, mortality, prognostic factors and outcome

Q J Med.

Prospective study on the etiology of community-acquired pneumonia in childern and adults in Spain

Eur J Clin Microbiol Infect Dis.