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

J Am Geriatr Soc. 2001 May;49(5):571-6. doi: 10.1046/j.1532-5415.2001.49116.x.


Objectives: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative 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%) predominantly 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 controls. 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 patients 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.

Publication types

  • Comparative Study

MeSH terms

  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Autopsy
  • Bronchitis / complications*
  • Bronchitis / pathology*
  • Case-Control Studies
  • Cause of Death*
  • Chronic Disease
  • Emphysema / complications*
  • Emphysema / pathology*
  • Female
  • Geriatrics
  • Hospital Mortality*
  • Hospitals, Special
  • Humans
  • Male
  • Myocardial Infarction / etiology*
  • Odds Ratio
  • Pneumonia / etiology*
  • Pulmonary Embolism / etiology*
  • Respiratory Insufficiency / etiology*
  • Risk Factors
  • Switzerland / epidemiology