The impact of community-acquired pneumonia on the health-related quality-of-life in elderly

Marie-Josée J Mangen, Susanne M Huijts, Marc J M Bonten, G Ardine de Wit, Marie-Josée J Mangen, Susanne M Huijts, Marc J M Bonten, G Ardine de Wit

Abstract

Background: The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period.

Methods: In a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in community-dwelling persons of ≥65 years, health-related quality-of-life was assessed in 562 subjects hospitalized with suspected community-acquired pneumonia (i.e. diseased cohort) and 1145 unaffected persons (i.e. non-diseased cohort) matched to pneumonia cases on age, sex, and health status (EQ-5D-3L-index). Health-related quality-of-life was determined 1-2 weeks after hospital discharge/inclusion and 1, 6 and 12 months thereafter, using Euroqol EQ-5D-3L and Short Form-36 Health survey questionnaires. One-year quality-adjusted life years (QALY) were estimated for both diseased and non-diseased cohorts. Separate analyses were performed for pneumonia cases with and without radiologically confirmed community-acquired pneumonia.

Results: The one-year excess QALY loss attributed to community-acquired pneumonia was 0.13. Mortality in the post-discharge follow-up year was 8.4% in community-acquired pneumonia patients and 1.2% in non-diseased persons (p < 0.001). During follow-up health-related quality-of-life was persistently lower in community-acquired pneumonia patients, compared to non-diseased persons, but differences in health-related quality-of-life between radiologically confirmed and non-confirmed community-acquired pneumonia cases were not statistically significant.

Conclusions: Community-acquired pneumonia was associated with a six-fold increased mortality and 16% lower quality-of-life in the post-discharge year among patients surviving hospitalization for community-acquired pneumonia, compared to non-diseased persons.

Trial registration: ClinicalTrials.gov, NCT00812084 .

Keywords: Community-acquired pneumonia; Elderly; Follow-up; Mortality; Quality-of-life.

Figures

Fig. 1
Fig. 1
Flow chart of CHO-CAP study. *Due to logistical reasons the first 14.7% of CAPiTA-participants were not invited to participate in the CHO-CAP study
Fig. 2
Fig. 2
Profile of the population, using the EQ5D instrument: Percentage reporting any problems per domain at different contact moments for the suspected pneumonia cases and the non-diseased subjets, respectively. Note: No significant difference at baseline (i.e. at vaccination) in any domain. Significant differences (p < 0.05) for all domains on all contact moments during the follow-up period
Fig. 3
Fig. 3
SF-36 mean scale scores at different contact moments for the suspected pneumonia cases and the non-diseased subjets, respectively. Abbreviations: PF = Physical Function; RP = Role-Physical; BP = Bodily Pain; GH = General Health; VT = Vitality; SF = Social Functioning; RE = Role-Emotional; MH = Mental Health

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