Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont.
CMAJ Open. 2020 Apr 28;8(2):E273-E281. doi: 10.9778/cmajo.20190074. Print 2020 Apr-Jun.
Deaths from respiratory tract infections (RTIs) in children are preventable through timely access to public health and medical interventions. We aimed to assess whether socioeconomic disparities in mortality related to pediatric RTI persisted after accounting for health status at birth.
We compared the prevalence of and risk factors for RTI-related death in singletons aged 28 days to 4 years across Ontario (Canada), Scotland and England (jurisdictions with universal health care) using linked administrative data for 2003-2013. We estimated rates of RTI-related mortality for children living in deprived areas and those born to teenage girls; we estimated both crude rates and those adjusted for health status at birth.
A total of 1 299 240 (Ontario), 547 556 (Scotland) and 3 910 401 (England) children were included in the study. Across all jurisdictions, children born in the most deprived areas experienced the highest rates of RTI-related mortality. After adjustment for high-risk chronic conditions and prematurity, we observed differences in mortality according to area-level deprivation in Ontario and England but not in Scotland. In Ontario, teenage motherhood was also an independent risk factor for RTI-related mortality.
Socioeconomic disparities played a substantial role in child mortality related to RTI in all 3 jurisdictions. Context-specific investigations around the mechanisms of this increased risk and development of programs to address socioeconomic disparities are needed.
通过及时获得公共卫生和医疗干预，可预防儿童呼吸道感染（RTI）导致的死亡。本研究旨在评估在考虑出生时健康状况后，与儿科 RTI 相关的死亡率的社会经济差异是否仍然存在。
我们使用 2003 年至 2013 年的关联行政数据，比较了安大略省（加拿大）、苏格兰和英格兰（具有全民医疗保健的管辖区）28 天至 4 岁单胎儿童的 RTI 相关死亡的流行率和危险因素。我们估计了生活在贫困地区的儿童和少女所生孩子的 RTI 相关死亡率；我们估计了未调整和根据出生时健康状况调整后的死亡率。
共有 1 299 240 名（安大略省）、547 556 名（苏格兰）和 3 910 401 名（英格兰）儿童纳入了研究。在所有管辖区，出生在最贫困地区的儿童经历 RTI 相关死亡率最高。在调整了高风险慢性疾病和早产后，我们观察到安大略省和英格兰的地区贫困程度与死亡率之间存在差异，但苏格兰没有。在安大略省，少女母亲也是 RTI 相关死亡率的独立危险因素。
在所有 3 个管辖区，社会经济差异在与 RTI 相关的儿童死亡中起了很大作用。需要针对这种风险增加的机制进行具体的调查，并制定解决社会经济差异的方案。
