幼児期に下気道感染症にかかると、大人になってから呼吸器疾患で死亡するリスクが高くなると言われています。 Contracting a lower respiratory tract infection in early childhood has been linked to a higher risk of dying from respiratory disease as an adult.
2023-03-07 インペリアル・カレッジ・ロンドン(ICL)
特にLRTIに苦しんだ場合の早期死亡率は、一般的に疾患にかかっていなかった人々のそれよりも高くなった。この研究により、LRTIが成人期の死亡率と関係があることが初めて明らかになった。これは、公衆衛生施策の改善や予防接種、健康診断、貧困対策の必要性を訴えるものだ。
<関連情報>
- https://www.imperial.ac.uk/news/243593/respiratory-disease-early-childhood-linked-higher/
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00131-9/fulltext
英国における幼児期の下気道感染と呼吸器疾患による成人早期の死亡:全国出生コホート研究 Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study
James Peter Allinson, Nishi Chaturvedi,Andrew Wong, Imran Shah, Gavin Christopher Donaldson, Jadwiga Anna Wedzicha, Rebecca Hardy
The Lancet Published:March 07, 2023
DOI:https://doi.org/10.1016/S0140-6736(23)00131-9
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.
Funding
National Institute for Health and Care Research Imperial Biomedical Research Centre, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, Royal Brompton and Harefield Hospitals Charity and Imperial College Healthcare NHS Trust, UK Medical Research Council.
