P&I is a syndromic indicator, not an etiologic one.P&I is confounded by design when many pathogens can produce the same clinical outcome (pneumonia) that gets coded similarly on death certificates. 😏The P&I category was created decades ago as a broad syndromic proxy for influenza-associated mortality when widespread, rapid, specific viral testing didn’t exist. It has served as a reasonable long-term broad proxy for respiratory mortality burden (especially when influenza was a major seasonal dri