Pediatric bronchitis and pneumonia double the risk of respiratory death in early adulthood

AS Dr. James P. Allinson

Credit: Research Gate

Children who experience a lower respiratory tract infection have a 93% increased risk of early adult death. respiratory disease than those who don’t, according to new data from the UK.

A team of researchers from Imperial College London reported an almost doubled risk of respiratory infections in infancy, including bronchitis and pneumonia, in a longitudinal observational cohort assessment of patients over 80 years in the UK. bottom. Moreover, these early affected patients accounted for more than 20% of his premature adult deaths from respiratory diseases in England and Wales between 1972 and 2019.

Researchers led by Dr. James P. Allinson, a consultant respiratory physician at the Royal Brompton Hospital, found an association between early childhood lower respiratory tract infections and overall risk and burden of early adult mortality from respiratory disease. An analysis was performed to estimate . Although common prevention strategies for respiratory illness in adulthood have focused on avoidance of exposure in adulthood, such as smoking cessation, historically, exposure to respiratory infections in childhood precludes adulthood in the future. It has been hypothesized that it may be subject to burden.

“Although many studies have linked lower respiratory tract infections in childhood to decreased lung function in adults, there are no lifetime studies that quantify the potential contribution of respiratory disease to early adult mortality.” they are writing

Allinson et al. conducted a prospective longitudinal observational analysis of nationally representative cohort data from the Medical Research Council National Survey of Health and Development (NSHD), which recruited patients at birth in England, Scotland, and Wales in March 1946. Did. sought results for an association between lower respiratory tract infections in children younger than 2 years and deaths from respiratory diseases he aged 26–73 years.

The hazard ratios (HR) and population-related risks associated with such childhood infections were estimated using the competing risks Cox proportional hazards model, and were determined by childhood socioeconomic status, home overcrowding, and birth time. Adjustments were made for weight, sex, and smoking status at ages 20–25. Apart from comparing mortality in this cohort with national mortality, the team further estimated the total and proportion of excess mortality due to this association among national populations.

The first survey recruited 5362 participants in March 1946. About three-quarters (n = 4032) continued to participate when she was 20-25 years old. Investigators excluded approximately 500 participants due to incomplete early childhood data, smoking status, or high mortality. Her 3589 participants aged 26 were included in the final analysis from 1972 to the present. 51% were men, with a maximum follow-up of 47.9 years.

The team observed 913 (25%) patients with lower respiratory tract infections during childhood. They had a significantly increased risk of dying from respiratory disease by age 73 years over those without such infections (adjusted HR, 1.93; 95% CI, 1.10–3.37; P. = .021).

Overall, patients who experienced lower respiratory tract infections during childhood accounted for 20.4% of all premature respiratory disease deaths in adults (95% CI, 3.8 – 29.8). Investigators believe this cohort caused 179,188 excess deaths in England and Wales between 1972 and 2019 (95% CI, 33,806 – 261,519).

The researchers noted that adult pulmonary dysfunction may be “a plausible intermediary linking childhood infections and adult mortality from respiratory causes.”

“Infection may impair or reflect already impeded lung development in childhood, leading to decreased peak pulmonary function in adulthood, leading to respiratory morbidity and mortality. “Importantly, the relationship between LRTI in childhood and lung function in adults appears to be modifiable by adolescent smoking and asthma,” they wrote. We may interfere with the catch-up growth that occurs naturally during puberty.”

As such, they emphasized the importance of identifying infants with lower respiratory tract infections and seeking means to optimize respiratory health and development into adulthood.

“Childhood poverty, a pervasive factor in childhood respiratory disease, remains common worldwide, which explains the link between early childhood (lower respiratory tract infections) and later adult mortality.” No, but because of poor environmental conditions, children with NSHD are prone to developing respiratory infections in the first place,” they concluded. “Not only improving child health, but addressing child poverty around the world can help avoid perpetuating health inequalities across lives, across generations and across communities. there is.”

References

1. ^{Allinson JP et al. Early adult mortality from childhood lower respiratory tract infections and respiratory diseases in the United Kingdom: a national birth cohort study. lancet. Published March 7, 2023 https://doi.org/10.1016/S0140-6736(23)00131-9}