Most of the studies of CAP have examined the short-term outcomes of the illness, focusing on either 30-day or inpatient mortality. Kaplan and colleagues1used a Medicare database to perform a matched case-control study to evaluate the long-term impact (ie, 1-year mortality rate) of older patients with CAP. The authors compared 158,960 CAP patients to 794,333 hospitalized control subjects (5 for each patient) matching for age, sex, and race. While the in-hospital mortality rate for CAP patients exceeded that of control subjects (11% vs 5.5%, respectively), the differences in the 1-year mortality rate were even more dramatic (40.9% vs 29.1%, respectively) [Fig 1
]. The high mortality rate was impressive, and the differences could not be explained by the types of underlying disease; the findings persisted, even if only the hospital survivors were examined. These findings make it clear that CAP is much more than a self-limited illness for those who survive, and that the 1-year mortality rate of elderly patients with CAP is four times higher than the in-hospital mortality rate, with one in three survivors of CAP dying in the subsequent year, following hospital discharge. The exact cause of death was not examined in the study, but the population was generally elderly, with 85% being > 65 years of age; nursing home patients were included, and 70% had a comorbid medical illness. The findings expand on an older Scandinavian study2 that reported a lower 10-year survival rate in CAP patients > 60 years of age than in an age-matched population without CAP. In that study, the relative risk for death in CAP patients was 1.5 compared to those without CAP, and the 10-year survival rate was 39%, compared to 61% in the non-CAP population, with many of the deaths related to cardiovascular disease and subsequent pneumonia. All of these data make it very clear that CAP requiring hospital admission is a disease that should be prevented, whenever possible, in the elderly.