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Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
A retrospective population-based cohort study identifying target areas for prevention of acute lower respiratory
Hannah C Moore1, Nicholas de Klerk, Peter Richmond
1Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia. hannahm@ichr.uwa.edu.au
Insights
Acute lower respiratory infections (ALRI) pose a significant hospitalization risk for young children. Key preventable risk factors include maternal smoking, birth season, and socioeconomic factors, especially for Aboriginal children.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Acute lower respiratory infections (ALRI) are a leading cause of hospitalization in young children.
- Understanding population attributable fractions (PAFs) of risk factors for ALRI is crucial for targeted prevention, particularly concerning disparities between Indigenous and non-Indigenous populations.
Purpose of the Study:
- To investigate the population attributable fractions (PAFs) of known infant and maternal risk factors for ALRI hospitalizations.
- To inform public health strategies by identifying high-risk groups and modifiable risk factors for ALRI.
Main Methods:
- A retrospective, population-based data linkage study was conducted in Western Australia.
- Data from 245,249 singleton births between 1996 and 2005 were analyzed.
- Multiple logistic regression was used to calculate PAFs for ALRI hospitalizations.
Main Results:
- ALRI hospitalization rates were significantly higher in Aboriginal children (93.0/1,000 person-years) compared to non-Aboriginal children (16.1/1,000 person-years).
- Significant risk factors for ALRI in both groups included male gender, autumn birth, preterm birth (<33 weeks), and high maternal parity.
- Key PAFs for non-Aboriginal children included maternal smoking (6.3%), autumn birth (12.3%), high maternal parity (15.4%), and elective cesarean (4.1%).
- For Aboriginal children, high maternal parity (16.5%), remote location (11.7%), young maternal age (<20 years) (11.2%), and socioeconomic disadvantage (18.4%) were significant PAFs.
Conclusions:
- Maternal smoking during pregnancy is a key modifiable risk factor for ALRI across all populations.
- Targeted interventions should address elective cesarean rates in non-Aboriginal women and focus on reducing teenage pregnancies, improving access to services, and enhancing living conditions for Aboriginal populations.
- Understanding these PAFs can guide effective public health interventions to prevent childhood ALRI hospitalizations.
Background:
Acute lower respiratory infections (ALRI) are a major cause of hospitalisation in young children. Many factors can lead to increased risk of ALRI in children and predispose a child to hospitalisation, but population attributable fractions for different risk factors and how these fractions differ between Indigenous and non-Indigenous children is unknown. This study investigates population attributable fractions of known infant and maternal risk factors for ALRI to inform prevention strategies that target high-risk groups or particular risk factors.
Methods:
A retrospective population-based data linkage study of 245,249 singleton births in Western Australia. Population attributable fractions of known maternal and infant risk factors for hospitalisation with ALRI between 1996 and 2005 were calculated using multiple logistic regression.
Results:
The overall ALRI hospitalisation rate was 16.1/1,000 person-years for non-Aboriginal children and 93.0/1,000 for Aboriginal children. Male gender, being born in autumn, gestational age <33 weeks, and multiple previous pregnancies were significant risk factors for ALRI in both Aboriginal and non-Aboriginal children. In non-Aboriginal children, maternal smoking during pregnancy accounted for 6.3% (95%CI: 5.0, 7.6) of the population attributable fraction for ALRI, being born in autumn accounted for 12.3% (10.8, 13.8), being born to a mother with three or more previous pregnancies accounted for 15.4% (14.1, 17.0) and delivery by elective caesarean accounted for 4.1% (2.8, 5.3). In Aboriginal children, being born to a mother with three or more previous pregnancies accounted for 16.5% (11.8, 20.9), but remote location at birth accounted for 11.7% (8.5, 14.8), maternal age <20 years accounted for 11.2% (7.8, 14.5), and being in the most disadvantaged socio-economic group accounted for 18.4% (-6.5, 37.4) of the population attributable fraction.
Conclusions:
The population attributable fractions estimated in this study should help in guiding public health interventions to prevent ALRI. A key risk factor for all children is maternal smoking during pregnancy, and multiple previous pregnancies and autumnal births are important high-risk groups. Specific key target areas are reducing elective caesareans in non-Aboriginal women and reducing teenage pregnancies and improving access to services and living conditions for the Aboriginal population.
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