Early LRTI is associated with risk of early adult death from respiratory disease

In an 80-year prospective cohort study, lower respiratory tract infections (LRTIs) in childhood almost double the risk of premature death from respiratory disease in adulthood.

A study of over 3,500 individuals born in the UK found that participants diagnosed with LRTI by the age of 2 years were 93% more likely to die early in adulthood from respiratory illness. (adjusted HR 1.93, 95% CI 1.10-3.37, P.=0.021), reported by James Peter Allinson, M.D., Ph.D., National Heart and Lung Institute, Imperial College London, et al.

This increased risk was also correlated with the number of documented LRTIs, with almost three times higher risk of acquiring 3 or more infections when compared to participants who did not have an LRTI in early childhood. (HR 2.87, 95% CI 1.18-7.02).

In addition, children requiring inpatient care for LRTI were at least four times more likely to die early in adulthood from respiratory disease (HR 4.35, 95% CI 1.31-14.5), Allinson’s team found lancet.

“Adult pulmonary dysfunction is a plausible mediator linking childhood infections and adult mortality from respiratory causes,” the group suggested. “Infection impairs childhood lung development.” or may reflect already being inhibited, leading to lower peak pulmonary function in adulthood and an increased risk of respiratory disease and mortality.”

Of the 52 adult premature deaths from respiratory disease identified in the cohort, chronic obstructive pulmonary disease (COPD) was the leading cause in 60%, followed by acute LRTI in 13%.

At the population level, researchers estimated that 20.4% (95% CI 3.8-29.8) of early adult deaths from respiratory disease could be attributed to LRTI in childhood. Smoking in adulthood was estimated to account for 57.7% (95% CI 37.3-68.0) of such premature deaths.

“Current preventive measures against respiratory disease in adults focus primarily on adult lifestyle risk factors such as smoking. Being associated with common infectious diseases years ago shows that risks need to be targeted well before adulthood,” Allinson said. press release.

“There is a need to optimize child health, particularly by tackling child poverty, to prevent the perpetuation of existing adult health inequalities,” he added. Evidence suggestive of origin also helps challenge the prejudice that all deaths from diseases such as COPD are linked to lifestyle factors.”

and accompanying commentsHeather J. Zar, MD, PhD, University of Cape Town, South Africa and Andrew Bush, MD, Imperial College London, emphasized the importance of preventing LRTIs during early childhood.

“The unavailability or unaffordability of current effective childhood immunizations against LRTIs, especially pneumococcal conjugate vaccines, remains a significant problem for LMICs. [low- and middle-income countries]global coverage of eligible children is only about 40%,” they wrote. and may further reduce the burden of LRTIs.”

“If such effective strategies are imminent, the overall burden of preventable disease could be substantial,” Zar and Bush said. If the relationship between LRTI in childhood and mortality in young adults is causal, as previously reported, these interventions have the potential to significantly reduce early mortality, especially in preventing early LRTI in LMICs. To do so, ensuring equitable global access to such interventions is critical to reducing morbidity and mortality throughout the life course.”

For this study, the British Medical Research Council’s National Survey of Health and Development prospectively collected data in England, Scotland and Wales on over 5,000 participants registered at birth in March 1946. bottom. A total of 3,589 remained in the study at her age of 26 and had complete childhood data, smoking history, and mortality information for the current analysis.

A total of 913 (25%) had at least 1 LRTI before the age of 2 years, most occurred within the first year of life, and only 1 infection was documented.

With up to 47.9 years of follow-up, 674 premature deaths occurred by age 73 years, with cancer (41%) and cardiovascular disease (27%) being the main causes. External causes (10%), respiratory disease (8%) and other causes (14%) accounted for the rest.

Excluding COPD and acute LRTI, premature death from respiratory disease included 8% interstitial lung disease, 8% asthma, 6% bronchiectasis, 4% external respiratory disease, and other respiratory diseases. Organ disease was included in 2%.

The main analyzes adjust for multiple factors, including birth weight and gender, environmental factors such as childhood home overcrowding, childhood socioeconomic status, and smoking status as an adult.

Not surprisingly, participants who smoked in data from 20 to 25 years of age also had an increased risk of early death from respiratory disease (HR 3.73, 95% CI 1.90-7.30).

Study limitations included “undocumented factors, including parental smoking and prematurity,” as well as those inherent in population-based studies, such as unmeasured confounding, the authors said. There is