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Link between childhood respiratory infections and early death – UK study

Scientists have found that respiratory infections, like bronchitis or pneumonia, in early childhood, will nearly double the risk of dying prematurely from respiratory diseases as an adult, and that addressing childhood exposure to this form of disease could save
hundreds of thousands of lives every year.

The study, published in The Lancet, followed a British cohort of more than 3 500 people from their births in 1946, and then again between the ages of 26 and 73. They found that those who contracted lower respiratory tract infections (LRTIs) like bronchitis or pneumonia before the age of two were 93% likelier to die early.

This was after adjustment had been made for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking, reports Health Policy Watch.

“Childhood LRTIs have been shown to be linked to the development of adult lung function impairments, asthma, and chronic obstructive pulmonary disease, but no previous study has had long enough follow-up to prospectively connect these early childhood infections to adult mortality,” the researchers, from Imperial College London, pointed out.

The risk of premature death caused by respiratory diseases in England and Wales is small, sitting at just 1.1% on average. For those who suffered LTRIs as infants, that risk jumps to 2.1%.

The study found this increased risk accounted for one in five premature respiratory disease deaths in England and Wales between 1972 and 2019, compared with three in five caused by smoking.

Globally, the chronic respiratory disease burden is significantly higher. In 2017, respiratory diseases accounted for an estimated 7% of worldwide deaths, killing 3.9m people.

Chronic obstructive pulmonary disease (COPD) caused the majority of these deaths, 90% of which occurred in low- and middle-income countries. By 2030, the World Health Organisation projects COPD will be the third leading cause of death in the world.

While the Non-Communicable Disease Alliance notes that “the reasons for its increasing prevalence in low- and middle-income countries are not well understood”, the study’s findings indicate that tackling childhood exposure to respiratory disease could save hundreds of thousands of lives every year.

“To prevent the perpetuation of existing adult health inequalities we need to optimise childhood health, not least by tackling childhood poverty,” said Dr James Allinson of Imperial College London, lead author of the study. “Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.”

The increased risk identified in the study affected participants regardless of socioeconomic background or whether they were smokers, challenging the conventional wisdom that adult mortality from respiratory diseases is exclusively linked to lifestyle choices like smoking.

The findings also build on previous studies demonstrating links between infants contracting respiratory diseases and lung function impairments, asthma, and chronic pulmonary disease in adulthood.

Researchers hope the mounting evidence of the long-term impacts of respiratory illness in children later in life will contribute to shape global health response strategies to hit the Sustainable Development Goal of reducing non-communicable disease burden by a third by 2030.

“Current global efforts to reduce premature adult mortality focus largely on adult exposures,” said Heather Zar, chair of the Department of Paediatrics and Child Health at Red Cross Children’s Hospital and professor at the University of Cape Town who wrote the editorial accompanying the report’s release.

“Ensuring equitable global access to such interventions to prevent early life LRTI, particularly in low- and middle-income countries, will be crucial to reduce morbidity and mortality through the life course.”

Study details

Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study

James Allinson, Nishi Chaturvedi, Andrew Wong, Imran Shah, Gavin Donaldson, Jadwiga Wedzicha, et al.

Published in The Lancet on 7 March 2023

Summary

Background
Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. We aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease.

Methods
This longitudinal observational cohort study used data collected prospectively by the Medical Research Council National Survey of Health and Development in a nationally representative cohort recruited at birth in March, 1946, in England, Scotland, and Wales. We evaluated the association between LRTI during early childhood (age <2 years) and death from respiratory disease from age 26 through 73 years. Early childhood LRTI occurrence was reported by parents or guardians. Cause and date of death were obtained from the National Health Service Central Register. Hazard ratios (HRs) and population attributable risk associated with early childhood LRTI were estimated using competing risks Cox proportional hazards models, adjusted for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and smoking at age 20–25 years. We compared mortality within the cohort studied with national mortality patterns and estimated corresponding excess deaths occurring nationally during the study period.

Findings
5362 participants were enrolled in March, 1946, and 4032 (75%) continued participating in the study at age 20–25 years. 443 participants with incomplete data on early childhood (368 [9%] of 4032), smoking (57 [1%]), or mortality (18 [<1%]) were excluded. 3589 participants aged 26 years (1840 [51%] male and 1749 [49%] female) were included in the survival analyses from 1972 onwards. The maximum follow-up time was 47·9 years. Among 3589 participants, 913 (25%) who had an LRTI during early childhood were at greater risk of dying from respiratory disease by age 73 years than those with no LRTI during early childhood (HR 1·93, 95% CI 1·10–3·37; p=0·021), after adjustment for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking. This finding corresponded to a population attributable risk of 20·4% (95% CI 3·8–29·8) and 179 188 (95% CI 33 806–261 519) excess deaths across England and Wales between 1972 and 2019.

Interpretation
In this prospective, life-spanning, nationally representative cohort study, LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths.

 

The Lancet article – Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study (Open access)

 

The Lancet linked editorial – Early childhood lower respiratory tract infection: a key determinant of premature adult respiratory mortality (Open access)

 

Health Policy Watch article – Childhood Respiratory Infections Are Linked to Premature Deaths in Adults (Open access)

 

See more from MedicalBrief archives:

 

Respiratory virus killing 100,000 children a year – systemic analysis

 

Abnormal sodium levels predict COVID-19 death or respiratory failure

 

High number of South African children with severe asthma – experts

 

Short-course of antibiotics suffices for children with pneumonia

 

 

 

 

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