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Hospital-based case-control study of bronchiectasis in indigenous children in Central Australia
Patricia C Valery1, Paul J Torzillo, Kim Mulholland
1Queensland Institute of Medical Research, Population Studies and Human Genetics, Brisbane, Australia.
Insights
Hospitalized pneumonia, especially severe or recurrent episodes in infancy, strongly increases the risk of developing bronchiectasis in Indigenous children. Breastfeeding showed a protective effect against this condition.
Area of Science:
- Pediatric respiratory health
- Epidemiology of childhood lung disease
Background:
- Childhood pneumonia is suspected to precede bronchiectasis development.
- No prior case-control studies have investigated this association.
- This study addresses the link between pneumonia hospitalizations and bronchiectasis risk.
Purpose of the Study:
- To examine the association between childhood pneumonia hospitalizations and the risk of developing radiologically confirmed bronchiectasis.
- To identify specific pneumonia characteristics and early life factors associated with bronchiectasis in Indigenous children.
Main Methods:
- A case-control study design was employed using medical records.
- The study focused on Indigenous children in Central Australia.
- Cases (61) with bronchiectasis were matched with 183 controls by gender, age, and diagnosis year.
Main Results:
- A significant association was found between pneumonia hospitalization history and bronchiectasis (OR 15.2).
- Recurrent, severe pneumonia, atelectasis, and oxygen requirement during hospitalization were strongly linked to bronchiectasis.
- Severe early-life pneumonia episodes, malnutrition, premature birth, and being small for gestational age were more prevalent in cases, while breastfeeding was protective.
Conclusions:
- Strong evidence supports an association between bronchiectasis and severe/recurrent pneumonia in infancy and childhood.
- The higher incidence of bronchiectasis in Indigenous children may be linked to these pneumonia-related factors.
- Further research is needed to fully elucidate the reasons for the disparity in bronchiectasis prevalence.
Background:
Childhood pneumonia has been reported to be associated with the development of bronchiectasis but there are no case-control studies that have examined this. This study examined the relationship between hospital admission for episode(s) of pneumonia and the risk of radiologically proven bronchiectasis.
Methods:
A medical record-based case-control study of bronchiectasis in Indigenous children was conducted in Central Australia. Controls (183), matched to cases (61) by gender, age and year of diagnosis, were Indigenous children hospitalized with other conditions.
Results:
There was a strong association between a history of hospitalized pneumonia and bronchiectasis [odds ratio (OR), 15.2; 95% confidence interval (95% CI) 4.4-52.7]. This was particularly evident in recurrent hospitalized pneumonia (P for trend < 0.01), severe pneumonia episodes with longer hospital stay (P for trend < 0.01), presence of atelectasis (OR 11.9; 95% CI 3.1-45.9) and requirement for oxygen (P for trend < 0.01). The overall number of pneumonia episodes, rather than its site, was associated with bronchiectasis. Although the total number of pneumonia episodes in the first year of life did not increase the risk of bronchiectasis, more severe episodes early in life did. Malnutrition, premature birth and being small for gestational age were more common findings among cases. Breast-feeding appeared to be a protective factor (OR 0.2; 95% CI 0.1-0.7).
Conclusions:
Although we cannot fully answer the question of why bronchiectasis is much more common in Indigenous children, we have provided strong evidence of an association between bronchiectasis and severe and recurrent pneumonia episodes in infancy and childhood.
