Patient- and Facility-Level Factors Associated With Long-Term Care Facility-Acquired Pneumonia and Mortality in Korea
In brief
Pneumonia affected 1 in 20 Korean care-home residents; mortality was fourfold higher
In a national cohort of 311,344 long-term care residents, 4.9% developed pneumonia, and 55% of those residents died in the facility compared with 13.9% without pneumonia. The observational study also linked patient and facility characteristics to pneumonia and mortality, but cannot establish cause and effect; its findings point to the need to address prevention and resource gaps.
- Journal
- Journal of the American Medical Directors Association (Q1)
- Published
- 22 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ji Hyun Yun, Hyun Kyun Ki, Jiho Park
- PMID
- 42966142
- DOI
- 10.1016/j.jamda.2026.106506
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 3 November 2026): Pneumonia risk and mortality in long-term care residents
Abstract
OBJECTIVES: To examine patient- and facility-level factors associated with pneumonia and long-term care facility (LTCF) mortality among residents of Korean LTCFs, as literature on this topic remains scarce. DESIGN: Retrospective cohort study using national health insurance claims data collected between January and December 2023. SETTING AND PARTICIPANTS: A total of 311,344 adults admitted to LTCFs across Korea were included. Residents with pneumonia-related codes within 1 week before admission or within 48 hours after admission were excluded. METHODS: Pneumonia was defined by the presence of a pneumonia-related International Classification of Diseases-10 code and the MT010 claims code, together with a systemic antibiotic prescription. Multivariate logistic regression and Cox proportional hazards regression analyses were used to evaluate factors associated with pneumonia and LTCF mortality, respectively. RESULTS: Among the 311,344 residents, 15,346 (4.9%) developed pneumonia. LTCF mortality was substantially higher among residents with pneumonia than among those without pneumonia (55.0% vs 13.9%). Older age, greater comorbidity burden, mechanical ventilation use, and admission from acute care hospitals were associated with higher odds of pneumonia and LTCF mortality. Pneumonia was independently associated with higher LTCF mortality (adjusted hazard ratio, 1.894; 95% CI, 1.857-1.932). At the facility level, larger bed capacity, rural location, and higher nurse and nursing assistant staffing levels were associated with higher odds of pneumonia, whereas rural location and lower physician and nurse staffing levels were associated with higher LTCF mortality. CONCLUSIONS AND IMPLICATIONS: Pneumonia was associated with substantial mortality among LTCF residents. Patient- and facility-level characteristics were associated with pneumonia and mortality, highlighting the importance of considering facility resources and geographic disparities in strategies for pneumonia prevention and management in LTCFs.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.