Childhood Respiratory Infections Are Linked to Premature Deaths in Adults
Respiratory infections
A national cohort study in England and Wales found respiratory infections before the age of two nearly doubled the odds of premature death from respiratory conditions.

Respiratory infections contracted in early childhood nearly double the risk of dying prematurely from respiratory diseases as an adult, according to a new study published in The Lancet.

The study followed a British cohort of over 3,500 people from their births in 1946, and then again between the ages of 26 and 73 years of age. They found that those who contracted lower respiratory tract infections (LRTIs) like bronchitis or pneumonia before the age of two were 93% more likely to die prematurely from respiratory diseases as an adult. This was after adjustment  was made for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking

“Childhood LRTIs have been shown to be linked to the development of adult lung function impairments, asthma, and chronic obstructive pulmonary disease, but no previous study has had long enough follow-up to prospectively connect these early childhood infections to adult mortality,” according to the study.

The risk of premature death caused by respiratory diseases in England and Wales is small, sitting at just 1.1% on average. For those who suffered LTRIs as infants, that risk jumps to 2.1%.

The study found this increased risk accounted for one in five premature respiratory disease deaths in England and Wales between 1972 and 2019, compared to three in five caused by smoking.

Globally, the chronic respiratory disease burden is significantly higher. In 2017, respiratory diseases accounted for an estimated 7% of worldwide deaths, killing 3.9 million people. Chronic obstructive pulmonary disease (COPD) caused the majority of these deaths, 90% of which occurred in low- and middle-income countries. By 2030, the World Health Organization projects COPD will be the third leading cause of death in the world.

While the Non-Communicable Disease Alliance notes that “the reasons for its increasing prevalence in low- and middle-income countries are not well understood,” the study’s findings indicate that addressing childhood exposure to respiratory disease could save hundreds of thousands of lives every year.

“To prevent the perpetuation of existing adult health inequalities we need to optimise childhood health, not least by tackling childhood poverty,” said Dr James Allinson of Imperial College London, lead author of the study. “Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.”

The increased risk identified in the study affected participants regardless of socioeconomic background or whether they were smokers, challenging the conventional wisdom that adult mortality from respiratory diseases is exclusively linked to lifestyle choices like smoking.

The findings also build on previous studies demonstrating links between infants contracting respiratory diseases and lung function impairments, asthma, and chronic pulmonary disease in adulthood.

Researchers hope the mounting evidence of the long-term impacts of respiratory illness in children later in life will contribute to shaping global health response strategies to hit the Sustainable Development Goal of reducing non-communicable disease burden by a third by 2030.

“Current global efforts to reduce premature adult mortality focus largely on adult exposures,” said Heather Zar, chair of the Department of Paediatrics and Child Health at Red Cross Children’s Hospital and professor at the University of Cape Town who wrote the editorial accompanying the report’s release.

“Ensuring equitable global access to such interventions to prevent early life LRTI, particularly in low- and middle-income countries, will be crucial to reduce morbidity and mortality through the life course.”

“We hope that this study will help guide international health organizations in tackling this issue,” study co-author Rebecca Hardy of Loughborough University said.

Image Credits: Kelly Sikkema/ Unsplash.

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