According to one reading of a 1993 study published by British medical journal, The Lancet, Hillary Clinton has a 42 per cent chance of dying within two years of contracting the pneumonia which today saw her stumble and lose her balance in New York.

Another study, based on a much larger sample suggests that her chances of dying after a year at between 34.6% and 50.9%; the study reported by the Journal of the American Medical Association (JAMA) in 2003 was based on an examination of the fate of nearly 159,000 pneumonia patients while the Lancet study was based on just 141 patients.

If Clinton wins the US presidential election there is therefore between a one in three and one in two chance she could die in office, if these studies are to be believed. The Democratic candidate for the White House is 68 years old. Pneumonia is sometimes dubbed ‘The Old Man’s Friend’ because it speeds terminally ill and elderly patients to a quick and relatively peaceful and painless end.

The studies examined the medical histories of pneumonia patients who were hospitalised; Hillary Clinton has not yet been sent to hospital although plans for her to travel to California this week have been shelved because of her condition.

Late today, after a ‘medical episode’ at the 911 remembrance ceremony at the site of the twin towers downed by Al Qaeda controlled jets, it was disclosed by her physician that the Democratic candidate had been diagnosed with pneumonia on Friday. This followed weeks of speculation about her health, mostly from the Trump camp, caused by her periodic coughing fits:

Is pneumonia really the old man’s friend? Two-year prognosis after community-acquired pneumonia F.L Brancati, MD , J.W Chow, MD , M.M Wagener, MPH , S.J Vacarello , V.L Yu, MD DOI: http://dx.doi.org/10.1016/0140-6736(93)91887-R Please go to ScienceDirect to view the PDF Article Info Summary Abstract SummaryIs pneumonia “the old man’s friend”—a terminal event for patients who will otherwise die soon of underlying chronic disease? If so, chronological age might influence treatment policy. We investigated the predictors of 2-year mortality after patients’ admission to hospital for community-acquired pneumonia, and focused on the predictive value of age. In a prospective cohort study 141 consecutive patients were admitted to hospital with community-acquired pneumonia. Clinical, laboratory, and sociodemographic data were collected on admission. Comorbidity was categorised as mild, moderate, or severe by a physician based on the patient’s medical history. Survival was assessed at 24 months after discharge. 22 (16%) patients died in hospital. Of the remaining 119, 38 (32%) died over the next 24 months. In a Cox model, 2-year mortality was independently related to severe comorbidity (relative risk [RR]=9·4) or moderate comorbidity (RR=3·1), and to haematocrit less than 35% (RR=2·9) (all p≤0·005). However, compared with patients aged 18-44 years, patients aged 45-64 (RR=0·84), 65-74 (RR=1·28), and 75-92 (RR=1·99) were not significantly more likely to die during the 24 months after discharge (all p≥0·2). Old age should not be a sole criterion for withholding aggressive treatment of community-acquired pneumonia. JAMA Pneumonia – Still the Old Man’s Friend? Vladimir Kaplan, MD; Gilles Clermont, MD, CM, MSc; Martin F. Griffin, MS; Jan Kasal, MD; R. Scott Watson, MD, MPH; Walter T. Linde-Zwirble; Derek C. Angus, MD, MPH [ + ] Author Affiliations Arch Intern Med. 2003;163(3):317-323.

ABSTRACT Background Hospital mortality of patients admitted with community-acquired pneumonia (CAP) has been well described. However, the long-term survival of those discharged alive is less clear. We sought to determine long-term survival of patients hospitalized with CAP and compare the outcome with controls hospitalized for reasons other than CAP. Methods We performed a matched case-control analysis using the Medicare hospital discharge database from the first quarter of 1997. We compared all Medicare recipients 65 years or older hospitalized with CAP and controls matched for age, sex, and race hospitalized for reasons other than CAP. We measured 1-year mortality determined from the Medicare Beneficiary Entitlement file and the Social Security Administration. Results We identified 158 960 CAP patients and 794 333 hospitalized controls. Hospital mortality rates for the CAP cohort and hospitalized controls were 11.0% and 5.5%, respectively (P<.001). One-year mortality rates for the CAP cohort and hospitalized controls were 40.9% and 29.1%, respectively (P<.001). One-year mortality rates in hospital survivors of the CAP and control cohorts were 33.6% and 24.9%, respectively (P<.001). The difference in mortality between the CAP and control cohorts was not explained by underlying disease. Standardized against the general population, the risk of death for both cohorts decreased monthly but was still elevated 1 year after hospital discharge. The standardized mortality ratio was 2.69 (95% confidence interval, 2.47-2.93) for CAP patients and 1.93 (95% confidence interval, 1.79-2.08) for hospital controls. Conclusions Almost half of all elderly patients admitted for CAP die in the subsequent year, with most deaths occurring after hospital discharge. The mortality is considerably higher than that of either the general population or a control population hospitalized for reasons other than CAP.