Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia.
BMC Public Health. 2010 Dec 7;10:757. doi: 10.1186/1471-2458-10-757.
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.
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.
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.
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.
急性下呼吸道感染（ALRI）是导致幼儿住院的主要原因。许多因素会增加儿童患 ALRI 的风险，并使儿童住院的可能性增加，但不同危险因素的人群归因分数以及这些分数在原住民和非原住民儿童之间的差异尚不清楚。本研究旨在调查已知婴儿和产妇危险因素的人群归因分数，以制定针对高风险人群或特定危险因素的预防策略。
这是一项在西澳大利亚州进行的回顾性基于人群的病例对照研究，对 245249 例单胎出生进行了数据链接。使用多因素逻辑回归计算了 1996 年至 2005 年间 ALRI 住院的已知产妇和婴儿危险因素的人群归因分数。
非原住民儿童的 ALRI 住院率总体为 16.1/1000 人年，原住民儿童为 93.0/1000 人年。男性、秋季出生、胎龄<33 周和多次妊娠是原住民和非原住民儿童 ALRI 的显著危险因素。在非原住民儿童中，母亲在怀孕期间吸烟占 ALRI 人群归因分数的 6.3%（95%CI：5.0，7.6），秋季出生占 12.3%（10.8，13.8），母亲有三次或以上妊娠史占 15.4%（14.1，17.0），选择性剖宫产占 4.1%（2.8，5.3）。在原住民儿童中，母亲有三次或以上妊娠史占 16.5%（11.8，20.9），但出生地偏远占 11.7%（8.5，14.8），母亲年龄<20 岁占 11.2%（7.8，14.5），处于最不利的社会经济群体占人群归因分数的 18.4%（-6.5，37.4）。
本研究估计的人群归因分数应有助于指导预防 ALRI 的公共卫生干预措施。所有儿童的一个关键危险因素是母亲在怀孕期间吸烟，多次妊娠和秋季出生是重要的高危人群。具体的重点领域是减少非原住民妇女的选择性剖宫产，减少青少年妊娠，并改善原住民的服务和生活条件。
