Childhood bronchitis, pneumonia tied to premature respiratory death in adults

Dad holding sick baby

Regina Burganova / iStock

A UK birth cohort study that tracked participants from birth has linked contracting a lower respiratory tract infection (LRTI) such as bronchitis or pneumonia in early childhood with nearly double the risk of dying from respiratory disease by 73 years, although the absolute risk was low: 2% vs 1% in those without a history of childhood LRTI.

In the study, published yesterday in The Lancet, a team led by Imperial College London investigators analyzed data from the Medical Research Council National Survey of Health and Development. The survey was made up of a nationally representative group of 5,362 people in England, Scotland, and Wales recruited at birth in March 1946.

Of the 5,362 participants, 4,032 were still participating in the study at age 20 to 25 years, and 3,589 participants who were 26 years old in 1972 were included in the survival analyses from 1972 to 2019, when they were 73. Maximum follow-up was 47.9 years.

8% of premature deaths due to respiratory cause

Among the 3,589 participants in the analysis, 25% had an LRTI before age 2 years and were at higher risk for dying from respiratory disease by age 73 than those who didn't have an LRTI (2.1% vs 1.1%, for an increased risk of 93%) after adjustment for factors such as childhood socioeconomic status and adults smoking status.

By the end of the study, 19% of participants had died before age 73. Among these 674 premature adult deaths, 8% died of a respiratory disease, mostly chronic obstructive pulmonary disease (COPD). The result translated to a population attributable risk of 20.4% and 179,188 excess deaths (1 in 5 adult respiratory deaths) from 1972 to 2019.

For reference, adult smoking-related diseases were responsible for almost 3 of 5 deaths (57.7%) from respiratory disease over the same period (507,223 of 878,951 deaths).

The authors noted that other risk factors (eg, premature birth, parental smoking) may have also influenced the increased risk.

Optimizing childhood health

In an Imperial College London news release, lead author James Allinson, BMBCh, PhD, said that the focus of the prevention of adult respiratory disease has focused on lifestyle factors such as smoking.

"Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood," he said. "To prevent the perpetuation of existing adult health inequalities we need to optimise childhood health, not least by tackling childhood poverty."

Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.

James Allinson, BMBCh, PhD

Allinson added that the suggestion of the early-life origins of adult chronic diseases also helps challenge the stigma that all deaths from diseases such as COPD are related to lifestyle factors such as smoking.

Senior author Rebecca Hardy, PhD, of University College London, said that preventing childhood respiratory diseases could help reduce early deaths from respiratory disease later in life. "We hope that this study will help guide the strategies of international health organisations in tackling this issue," she said.

In a related commentary, Heather Zar, MD, PhD, of the University of Cape Town, and Andrew Bush, MD, of Imperial College London, said that while the prevention of early-childhood LRTIs is a priority, many families in other parts of the world are unable to access or afford effective vaccinations for their children, especially pneumococcal conjugate vaccine. As a result, only 40% of eligible children worldwide receive these vaccines.

Ensuring equitable access to these vaccines, as well as the new respiratory syncytial virus vaccine, could reduce global LRTI incidence, they said. "With such effective strategies imminent, the overall burden of preventable disease might be substantial," they wrote. "Furthermore, if the relationship between early childhood LRTI and premature adult mortality is causal, as suggested by this study, these interventions might substantially reduce premature mortality."

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