Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic
Maximiliane L Verfürden1, Ruth Gilbert1, Neil Sebire2
1Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
Insights
Children with chronic conditions face significantly higher risks of death from respiratory tract infections (RTIs) and sudden unexplained death (SUD). Some RTI deaths may be unavoidable due to terminal decline, highlighting the need for better death recording.
Area of Science:
- Pediatric Health
- Epidemiology
- Public Health
Background:
- Chronic conditions increase child mortality risk from preventable causes.
- Understanding the specific risks of respiratory tract infections (RTIs) and sudden unexplained death (SUD) in children with chronic conditions is crucial for targeted interventions.
- Previous research has not fully elucidated the differential impact of chronic conditions on these specific causes of child mortality.
Purpose of the Study:
- To determine the risk of death from RTIs and SUD in children with and without chronic conditions.
- To analyze these risks separately for infants (2-11 months) and young children (1-4 years).
- To identify potential differences in avoidability of RTI-related deaths based on underlying health status.
Main Methods:
- A whole-country birth cohort study utilizing linked administrative health databases in Scotland.
- Inclusion of children aged 2 months to less than 5 years between 2000 and 2014.
- Cox regression analysis adjusted for birth characteristics, socioeconomic status, and vaccination uptake to calculate Hazard Ratios (HR) for mortality.
Main Results:
- Chronic conditions were strongly associated with RTI mortality (HR 68.48 in infants, HR 38.32 in young children).
- Chronic conditions were also strongly associated with SUD (HR 2.42 in infants, HR 2.53 in young children).
- A significant proportion of RTI-related deaths (82.4%) and SUDs (17.4%) occurred in children with chronic conditions.
Conclusions:
- The high association between chronic conditions and RTI mortality suggests some deaths may be due to terminal decline and not preventable.
- Improved recording of expected deaths on death certificates could help identify potentially avoidable RTI-related deaths.
- Public health and healthcare strategies may need to be refined to better address mortality risks in children with chronic conditions.
Objective:
To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.
Design:
Whole-country, birth cohort study using linked administrative health databases from Scotland.
Setting And Participants:
Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.
Main Outcome Measures:
Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2-11 months and at 1-4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.
Results:
The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2-11 months: HR 68.48, 95% CI (40.57 to 115.60), 1-4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2-11 months: HR 2.42, 95% CI (1.67 to 3.63), 1-4 years: HR 2.53, 95% CI (1.36 to 4.71)).
Conclusions:
The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures.
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