注：本文由小咖机器人翻译整理

期刊来源：Lancet

文献发表时间：2023-03-07

原文链接：https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00131-9/fulltext#seccestitle130

内容如下：

总结

背景

众所周知，儿童早期的下呼吸器官感染（LRTIs）会影响肺部发育和终生肺部健康，但其与成人因呼吸系统疾病过早死亡的关系尚不清楚。我们的目的是评估儿童早期下呼吸道感染（LRTI）与呼吸系统疾病导致的成人过早死亡的风险和负担之间的关系。

方法

这项纵向观察性队列研究使用了医学研究委员会全国健康与发展调查（Medical Research Council National Survey of Health and Development）在1946年3月在英格兰、苏格兰和威尔士招募的全国代表性队列中前瞻性收集的数据。我们评估了儿童早期（年龄岁）下呼吸道感染（LRTI）与26-73岁呼吸系统疾病死亡之间的关系。儿童早期下呼吸道感染的发生由父母或监护人报告。从国家卫生服务中心登记处获得死亡原因和死亡日期。使用竞争风险Cox比例风险模型评估与儿童早期下呼吸道感染相关的风险比（HR）和人群归因风险，并对儿童社会经济地位、儿童家庭过度拥挤、出生体重、性别和20-25岁时吸烟进行调整。我们比较了队列研究中的死亡率与全国死亡率模式，并估计了研究期间全国范围内发生的相应超额死亡。

调查结果

1946年3月有5362名参与者入组，4032名（75%）在20-25岁时继续参与研究。排除了443名幼儿数据不完整（368[9%]，共4032名）、吸烟（57[1%]）或死亡（18[<1%]）的参与者。从1972年起，3589名26岁的参与者（1840[51%]为男性，1749[49%]为女性）被纳入生存分析。最长随访时间为47.9年。在3589名参与者中，913名（25%）在儿童早期有下呼吸道感染的人在73岁时死于呼吸系统疾病的风险高于儿童早期无下呼吸道感染的人（HR 1.93，95%CI 1.10–3.37；P=0.021），在对儿童期社会经济地位、儿童期家庭过度拥挤、出生体重、性别和成人吸烟进行调整后。这一发现与1972年至2019年间英格兰和威尔士20.4%（95%CI 3.8–29.8）和179188（95%CI 33806–261519）超额死亡的人群归因风险相对应。

解释

在这项前瞻性、终生、具有全国代表性的队列研究中，儿童早期LRTI与成人因呼吸系统疾病过早死亡的风险增加近两倍相关。占这些死亡人数的五分之一。

资助

国家卫生和保健研究所帝国生物医学研究中心，皇家布朗普顿和哈里菲尔德国家医疗服务（NHS）基金会信托，皇家布朗普顿和哈里菲尔德医院慈善和帝国学院医疗保健NHS信托，英国医学研究委员会。

英文原文内容如下：

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.