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Risk of Noncommunicable Diseases After Hospitalization for Community-Acquired Pneumonia
Julio Ramirez1,2, Stephen Furmanek1, Thomas Chandler1
1Norton Infectious Disease Institute, Norton Healthcare, Louisville, Kentucky, USA.
Background:
Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality. Increasing evidence suggests that CAP may contribute to long-term morbidity through the development of noncommunicable diseases (NCDs). We evaluate the risk for new NCDs following hospitalization for CAP.
Methods:
This was a retrospective matched cohort study of adults hospitalized between 1 June 2015 and 31 May 2016, using the Epic Cosmos database, with 5 years of follow-up. Adults hospitalized with CAP were matched 1:3 by age, sex, and race with adults hospitalized for non-CAP medical reasons. NCDs were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. For each NCD category (cardiovascular, pulmonary, central nervous system, metabolic, renal, and neoplastic), analyses were restricted to patients without a prior history of that specific NCD, thereby defining separate at-risk populations for each outcome. Absolute and population-based measures of risk were calculated. Exploratory analysis estimating the national excess of NCDs attributable to CAP was performed.
Results:
Among 207 848 CAP patients and 623 544 matched controls, CAP hospitalization was associated with significantly increased risk of new NCDs over 5 years. Pulmonary disease showed the greatest absolute burden with a number needed to harm of 14 (95% confidence interval [CI], 13-15). The estimated national excess of NCDs attributable to CAP in 1 year was 146 542 (95% CI, 132 677-161 716), driven primarily by pulmonary, cardiovascular, and renal diseases.
Conclusions:
CAP hospitalization is associated with a substantial and sustained increase in risk for new NCDs, supporting CAP as an acute infection that may trigger long-term multimorbidity.
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