Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
PLoS One. 2021 Apr 28;16(4):e0250181. doi: 10.1371/journal.pone.0250181. eCollection 2021.
To assess the risk of severe childhood infections within families, we conducted a sibling analysis in a population-based cohort study with genealogical linkage. We investigated the sibling risk of hospitalization with common infections, a marker of severity. We hypothesized that having siblings hospitalized for infection would increase the proband's risk of admission with infection.
We used population data on Western Australian live-born singletons and their siblings between 1980 and 2014. Measures of infection were infection-related hospitalizations from discharge diagnostic codes. Exposure was having a sibling who had an infection-related hospitalization. Outcomes were infection-related hospitalizations in the child/proband. Probands were followed until an infection-related hospitalization admission (up to the first three), death, 18th birthday, or end of 2014, whichever occurred first. Infection risks were estimated by adjusted Cox proportional hazard models for multiple events.
Of 512,279 probands, 142,915 (27.9%) had infection-related hospitalizations; 133,322 (26.0%) had a sibling with a previous infection-related hospitalization (i.e. exposed). Median interval between sibling and proband infection-related hospitalizations was 1.4 years (inter-quartile range 0.5-3.7). Probands had a dose-dependent increase in risk if sibling/s had 1, 2, or 3+ infection-related hospitalizations (adjusted hazard ratio, aHR 1.41, 95% CI 1.39-1.43; aHR 1.65, 1.61-1.69; aHR 1.83, 1.77-1.90, respectively). Among siblings with the same clinical infection type, highest sibling risks were for genitourinary (aHR 2.06, 1.68-2.53), gastrointestinal (aHR 2.07, 1.94-2.19), and skin/soft tissue infections (aHR 2.34, 2.15-2.54). Overall risk of infection-related hospitalization was higher in children with more siblings and with older siblings.
In this population-based study, we observed an increased risk of infection-related hospitalization in children whose siblings were previously hospitalized for infection. Public health interventions may be particularly relevant in families of children hospitalized with infection.
为了评估家庭内儿童严重感染的风险，我们在一项基于人群的队列研究中进行了兄妹分析，该研究具有谱系链接。我们调查了因常见感染住院的兄弟姐妹的患病风险，这是严重程度的一个标志。我们假设，兄弟姐妹因感染住院会增加先证者感染住院的风险。
我们使用了 1980 年至 2014 年期间西澳大利亚州活产单胎及其兄弟姐妹的人群数据。感染的衡量标准是因感染相关的出院诊断代码而住院。暴露因素是兄弟姐妹曾因感染相关疾病住院。结局是儿童/先证者因感染相关疾病住院。先证者在感染相关住院治疗（最多前三例）、死亡、18 岁生日或 2014 年底之前（以先发生者为准）进行随访。对于多次事件，使用调整后的 Cox 比例风险模型估计感染风险。
在 512279 名先证者中，有 142915 名（27.9%）发生了感染相关住院治疗；有 133322 名（26.0%）的兄弟姐妹曾因感染相关疾病住院（即暴露）。兄弟姐妹与先证者感染相关住院治疗的中位间隔时间为 1.4 年（四分位间距 0.5-3.7）。如果兄弟姐妹有 1、2 或 3 次或更多感染相关住院治疗，先证者的风险会呈剂量依赖性增加（调整后的危险比[aHR]为 1.41，95%可信区间[CI]为 1.39-1.43；aHR 为 1.65，1.61-1.69；aHR 为 1.83，1.77-1.90）。在具有相同临床感染类型的兄弟姐妹中，最高的兄弟姐妹患病风险为泌尿生殖系统（aHR 2.06，1.68-2.53）、胃肠道（aHR 2.07，1.94-2.19）和皮肤/软组织感染（aHR 2.34，2.15-2.54）。兄弟姐妹数量较多和年龄较大的儿童感染相关住院治疗的总体风险较高。
在这项基于人群的研究中，我们观察到先证者因兄弟姐妹先前因感染住院而导致感染相关住院治疗的风险增加。公共卫生干预措施可能在因感染住院的儿童的家庭中特别重要。
