Risk of Noncommunicable Diseases After Hospitalization for Community-Acquired Pneumonia

Abstract 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.