Cause of death in older patients with anatomo-pathological evidence of chronic bronchitis or emphysema: A case-control study based on autopsy findings

OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomopathological evidence and to compare the rel ative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women ) were autopsied between 1972 and 1996; mean age at death was 81.5 +/- 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients ( 26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predomina ntly E. Pneumonia was the most frequent cause of death in all patients (21. 8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5. 1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in c ontrols. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio (OR) = 1.89, P = .008) , or in controls (12.7%; OR = 1.56, P = .0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older pa tients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls.