Mortality risk in year following pneumonia hospitalization ‘substantial,’ study finds

In a new study, rates of all-cause mortality in the year after hospitalization for pneumonia were high and were associated with increasing age and a worse comorbidity profile, researchers reported in Respiratory Medicine.

“While several studies have evaluated mortality and hospital readmission among older adults who were admitted for pneumonia, few have evaluated these outcomes among younger adults and even fewer have evaluated these outcomes among adults of all ages on an overall basis as well as within subgroups defined by age and comorbidity profile, during the acute and long-term phases of pneumonia and its sequalae,” Ahuva Averin, an analyst at Policy Analysis Inc., Chestnut Hill, Massachusetts, and colleagues wrote.

The retrospective cohort study included 37,006 adults with at least one pneumonia hospitalization in the previous 1 year, with data culled from 2012 to 2018. Researchers identified cumulative risk for all-cause mortality during and after pneumonia hospitalization through 1-year post-discharge and all-cause readmissions post-discharge.

Overall, there were 38,809 pneumonia hospitalizations; 33% of patients had at-risk comorbidity conditions including chronic heart disease, chronic lung disease and diabetes and 55% had high-risk comorbidity conditions including malignancies/immunotherapy and chronic renal failure.

The rate of mortality was 3.5% in hospital, 8.2% from admission to 30 days post-discharge and 17.7% from admission to 360 days post-discharge.

Risk for mortality increased with older age. Rates were higher among individuals aged 85 years and older compared with 18 to 49 years for in-hospital mortality (5% vs. 0.6%), mortality at 30 days post-discharge (12.8% vs. 1.9%) and mortality at 360 days post-discharge (26% vs. 4.1%).

Rates were also higher among individuals with high-risk comorbidity profiles compared with healthy comorbidity profiles: in-hospital mortality (3.9% vs. 2.3%), mortality at 30 days post-discharge (9.6% vs. 5.1%) and mortality at 360 days post-discharge (21% vs. 10.8%).

Among the 37,453 pneumonia hospitalizations wherein patients were discharged, the rate of readmission was 12.5% within 30 days and 42.3% hospital within 360 days. Rates of readmission There was also an increase in proportion of readmissions within 30 days and within 360 days among individuals aged 18 to 49 years (11.9% and 34.1%) and was highest among individuals aged 65 to 74 years (14.2% and 44.9%). Increases in readmissions were also associated with a higher-risk comorbidity profiles compared with a healthy comorbidity profiles for rates within 30 days (15.1% vs. 6.4%) and within 360 days (47.6% vs. 24.9%).

“The findings from our study [reinforce] prior observations that all-cause mortality during the year subsequent to hospital admission for pneumonia is substantial, and is linked to increasing age and worsening comorbidity profile. Both readmission and mortality are greater at all ages in high-risk and at-risk groups compared with their healthy counterparts.

“While conclusive evidence directly linking pneumonia to persistent inflammation and premature death is still lacking, strategies aimed at preventing pneumonia and/or the pathophysiologic changes that follow pneumonia, especially among individuals with comorbidities, may reduce morbidity and mortality as well as health care costs,” the researchers wrote.