Affiliations: Milwaukee, WI
Dr. Effros is affiliated with the Medical College of Wisconsin.
Correspondence to: Richard M. Effros, MD, FCCP, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226; e-mail: email@example.com
In a study of 4,020 trauma patients, Johnston et al, in this issue of CHEST (see page 653), have shown that the relationship of age to the risk of developing ARDS is much more complicated than might be expected. There was a progressive increase in risk with age, reaching maximum values in patients who were 60 to 69 years old. However, the risk appeared to decline thereafter, and there was no greater risk in the group of patients who were > 80 years old than in patients who were 13 to 19 years old. The interpretation of this trend may be related in part to differences in the treatment of the very elderly, in whom a less aggressive approach is likely. However, alternative explanations are possible.
One consideration is the nature of the trauma. It is likely that many of the elderly sustained hip fractures, whereas the younger patients were involved in motor vehicle accidents. Rapid repair of hip fractures can greatly reduce the morbidity associated with this kind of trauma. Furthermore, having reached an advanced age represents something of an accomplishment and may be related to “clean living.” Although these problems were not tracked in this study, both alcohol1–
have been associated with an increased risk for ARDS. Since both of these addictions decrease longevity, it is quite possible that reduced morbidity in the oldest patients is simply related to a reduced incidence of drinking and smoking. In view of the high incidence of smoking and drinking in the American population, it is possible that much of the increased risk of ARDS that occurs with age up to the seventh decade is due to these factors rather than to any biological effect of aging. This would imply that a significant fraction of ARDS cases would be “preventable” if it were possible to minimize these social ills.
A more comprehensive analysis of historical data will be needed to discriminate among these different hypotheses. However, the study of Johnston et al demonstrates some of the difficulties associated with epidemiologic studies of ARDS.
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