Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
Arch Dis Child. 2018 Dec;103(12):1125-1131. doi: 10.1136/archdischild-2017-314098. Epub 2018 Jul 14.
To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.
Whole-country, birth cohort study using linked administrative health databases from Scotland.
Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.
Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2-11 months and at 1-4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.
The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2-11 months: HR 68.48, 95% CI (40.57 to 115.60), 1-4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2-11 months: HR 2.42, 95% CI (1.67 to 3.63), 1-4 years: HR 2.53, 95% CI (1.36 to 4.71)).
The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures.
确定具有不同病因的两种潜在可避免病因（呼吸道感染[RTI]和不明原因猝死[SUD]）导致的儿童死亡风险，这些儿童患有或不患有慢性疾病。
利用苏格兰全国性的、基于链接的医疗保健数据库的整群出生队列研究。
2000 年至 2014 年期间，苏格兰年龄在 2 个月至不到 5 岁的儿童。
RTI 或 SUD 相关死亡的相对风险（以 HR 表示），分别分析 2-11 个月和 1-4 岁儿童的死亡情况，并使用 Cox 回归调整出生特征、社会经济地位和疫苗接种率。
该队列共纳入 761172 名儿童。在活产儿中，有 9.6%（n=72901）记录有慢性疾病，82.4%（n=173）的 RTI 相关死亡和 17.4%（n=49）的 SUD 与慢性疾病有关。慢性疾病与 RTI 死亡率高度相关（2-11 个月：HR 68.48，95%CI（40.57 至 115.60），1-4 岁：HR 38.32，95%CI（23.26 至 63.14）），与 SUD 也密切相关（2-11 个月：HR 2.42，95%CI（1.67 至 3.63），1-4 岁：HR 2.53，95%CI（1.36 至 4.71））。
与慢性疾病的高度相关性表明，RTI 相关的死亡率有时可能是疾病终末期的结果，并非所有情况下都可以推迟或预防。在死亡证明上记录死亡是否可以预见，可以表明哪些 RTI 相关的死亡可以通过医疗和公共卫生措施来避免。
