Short‐Term Risk of Pneumonia After Fracture by Anatomical Site in Adults Aged 65 Years or Older: A Propensity Score–Matched
TriNetX
Cohort Study
Tetsuya Hiyoshi, Hiroaki Takeoka, Ryutaro Hashimoto, Yusuke Sechi, Hiroki Suzuyama, Shigeki Nabeshima ABSTRACT
Aim
To compare short‐term recorded pneumonia risk across fracture sites in adults aged 65 years or older, focusing on thoracic‐region versus lumbar‐region vertebral compression fracture (VCF).
Methods
This retrospective TriNetX cohort study included adults with a first qualifying recorded diagnosis of one of six fractures. Pair‐specific cohorts underwent 1:1 propensity score matching. The primary outcome was at least one recorded pneumonia diagnosis during Days 3–90; Days 3–30 were secondary.
Results
After matching, the maximum standardized mean difference was 0.031 or less in every comparison. In the primary analysis, 42 959 patients were included in each cohort. During Days 3–90, pneumonia occurred in 1469 patients (3.42%) after thoracic‐region VCF and 1171 (2.73%) after lumbar‐region VCF (risk ratio [RR], 1.25; 95% confidence interval [CI], 1.16–1.35); the 3–30‐day RR was 1.31 (95% CI, 1.17–1.46). Versus pair‐specifically matched distal‐radius cohorts, 3–90‐day RRs were 2.29 for thoracic‐region VCF, 1.91 for lumbar‐region VCF, 2.33 for proximal femur fracture, 1.97 for single‐rib fracture, and 2.39 for multiple‐rib fractures. Multiple‐rib fractures had greater risk than single‐rib fracture (RR, 1.24; 95% CI, 1.18–1.31).
Conclusions
Relative associations with recorded pneumonia were generally stronger during Days 3–30 than during Days 3–90. Risk was higher in the thoracic‐region VCF cohort than in the lumbar‐region VCF cohort and in the multiple‐rib fracture cohort than in the single‐rib fracture cohort. These findings may inform respiratory surveillance based on fracture site and rib‐fracture burden, subject to residual confounding and diagnostic‐code limitations.