Kawai Takumi, Goto Aya, Watanabe Eiko, Nagasawa Machiko, Yasumura Seiji
Department of Public Health, Fukushima Medical University School of Medicine, Health Promotion Division, Fukushima, Japan.
Pediatr Int. 2011 Aug;53(4):431-45. doi: 10.1111/j.1442-200X.2010.03285.x.
Epidemiologic evidence regarding the background factors of childhood infections in Japan is scarce. The aim of the present study was therefore to investigate the rates and associated factors of hospitalization for lower respiratory tract infections (LRTI) and gastrointestinal infections (GII) among children with birthweight ≥ 2500 g and ≥ 37 weeks of gestational age.
The data for the study were collected at 18-month health checkups in one city in Japan. The community database included information on the main outcome (past hospitalization) and 16 host, environmental, and parenting factors. The Kaplan-Meier method and log-rank test were used to determine sex differences in hospital admission for infection, and the Cox regression model to analyze sex-specific factors associated with the hospitalization.
The proportion of children who were admitted to hospital before their 18-month checkup was 7.1% for LRTI and 2.2% for GII. Hospital admission for LRTI among boys was higher than girls. Multivariate analysis indicated the following LRTI-associated factors: child-care attendance (hazard ratio [HR]= 1.97) and three or more adults living together (HR = 2.63) for boys; and child-care attendance (HR = 4.30) and two or more children living together (HR = 4.57) for girls. GII-associated factors were maternal age <25 years (HR = 3.45) for boys, and hand washing by caregivers after lavatory use and diaper changing (HR = 6.93) for girls.
One out of 11 children was hospitalized because of LRTI or GII during their first 18 months, which was associated with a biologic factor (sex), environmental factors (child-care attendance and family size), and parenting practices (shorter duration of exclusive breast-feeding and caregivers' unfavorable hygiene practices).
关于日本儿童感染背景因素的流行病学证据很少。因此，本研究的目的是调查出生体重≥2500克且胎龄≥37周的儿童中，下呼吸道感染（LRTI）和胃肠道感染（GII）的住院率及相关因素。
本研究的数据收集于日本一个城市的18个月健康检查。社区数据库包含主要结局（过去的住院情况）以及16个宿主、环境和育儿因素的信息。采用Kaplan-Meier法和对数秩检验来确定感染住院的性别差异，并使用Cox回归模型分析与住院相关的性别特异性因素。
在18个月检查前住院的儿童比例，LRTI为7.1%，GII为2.2%。男孩因LRTI住院的比例高于女孩。多变量分析表明，与LRTI相关的因素如下：男孩为入托（风险比[HR]=1.97）和与三名或更多成年人同住（HR = 2.63）；女孩为入托（HR = 4.30）和与两名或更多儿童同住（HR = 4.57）。与GII相关的因素，男孩为母亲年龄<25岁（HR = 3.45），女孩为照顾者在使用厕所和更换尿布后洗手（HR = 6.93）。
11名儿童中有1名在其出生后的前18个月因LRTI或GII住院，这与生物学因素（性别）、环境因素（入托和家庭规模）以及育儿方式（纯母乳喂养时间较短和照顾者不良卫生习惯）有关。
