Their study adds to a small but growing body of literature that indicates that CAP is associated with a mortality hazard that continues beyond recovery and hospital discharge.2-5 In general, there are a number of methodologic obstacles to estimating the mortality hazard that exists following pneumonia. These difficulties are exemplified in a recent systematic review of a large number of studies that have attempted to define the mortality hazard associated with pneumonia in another context: that is, the hospital mortality associated with ventilator-associated pneumonia (VAP).6 In a metaanalysis of 52 studies of VAP, the short-term mortality risk associated with VAP was 1.27 (relative risk; 95% CI, 1.15-1.39), surprisingly similar to the estimate of long-term mortality hazard for CAP found by Bordon et al1 (hazard ratio 1.4; 95% CI, 1.2-1.5). There were a variety of study designs and populations among these 52 studies and, as might be expected, there was considerable heterogeneity among the estimates for VAP-associated mortality derived from the 52 individual studies. Interestingly, dividing the 52 studies into those that were case controlled vs a more simple design, both the summary mortality hazard and the associated heterogeneity were found to be similar across the two subgroups. Moreover, the heterogeneity among the estimates for VAP-associated mortality could not easily be accounted for by the different types of patient populations, study quality scores, study designs,7 or even the study definition of VAP among the 52 studies. In short, this illustrates the difficulties in attempting to estimate the mortality hazard associated with pneumonia and that estimates may vary considerably across different studies.