Hardelid Pia, Dattani Nirupa, Cortina-Borja Mario, Gilbert Ruth
Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
BMC Public Health. 2014 Nov 20;14:1191. doi: 10.1186/1471-2458-14-1191.
Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified.
We analysed deaths in children resident in England who died of non-injury causes aged 28 days to 18 years between 2001 and 2010 using death certificates linked to a longitudinal hospital admission database. We defined deaths as RTI-related if RTIs or other respiratory conditions were recorded on death certificates or linked hospital records up to 30 days before death. We examined trends in mortality by age group, year and season (winter or summer) and determined the winter excess of RTI-related deaths using rate differencing techniques. We estimated the proportion of RTI-related deaths in children with chronic conditions.
22.4% (5039/22509) of child deaths were RTI-related. RTI-related deaths declined by 2.3% per year in infants aged 28 to 364 days between 2001 and 2010. No decline was observed for older children. On average there were 161 winter excess RTI-related deaths annually, accounting for 32% of all RTI-related deaths. 89.0% of children with RTI-related deaths had at least one chronic condition; neurological conditions were the most prevalent.
RTI-related deaths have not declined in the last decade except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.
呼吸道感染（RTIs）是儿童死亡的重要原因，并且常常导致慢性病患儿的病情终末期恶化。RTIs作为根本死因常常未被充分记录；因此，RTIs对儿童死亡的总体影响以及RTI相关死亡的潜在可预防性尚未得到充分量化。
我们利用与纵向住院数据库相链接的死亡证明，分析了2001年至2010年间居住在英格兰、死于非伤害原因、年龄在28天至18岁之间的儿童死亡情况。如果在死亡证明或与之相链接的医院记录中，在死亡前30天内记录了RTIs或其他呼吸道疾病，我们将这些死亡定义为与RTI相关。我们研究了按年龄组、年份和季节（冬季或夏季）划分的死亡率趋势，并使用率差技术确定与RTI相关死亡的冬季超额情况。我们估计了慢性病患儿中与RTI相关死亡的比例。
22.4%（5039/22509）的儿童死亡与RTI相关。在2001年至2010年间，28至364天的婴儿中，与RTI相关的死亡每年下降2.3%。年龄较大的儿童未观察到下降。平均每年有161例与RTI相关的冬季超额死亡，占所有与RTI相关死亡的32%。89.0%与RTI相关死亡的儿童至少有一种慢性病；神经疾病最为常见。
除婴儿外，过去十年中与RTI相关的死亡并未下降。预防RTIs冬季超额情况以及治疗儿童尤其是慢性病患儿RTIs的针对性策略，可能会减少与RTI相关的死亡。
