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Lower respiratory tract infection during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths in a Lancet study.
The study of 3,589 people over 73 years suggests that children who had a lower respiratory tract infection, such as bronchitis or pneumonia, by the age of two were almost twice as likely to die prematurely in adulthood from respiratory diseases, independent of socioeconomic factors and smoking status.
Authors say that these findings challenge the misconception that adult mortality from respiratory disease is only linked to smoking in adulthood, and highlight the need to implement interventions earlier in life to prevent childhood lower respiratory tract infection and improve the health of children suffering them.
Childhood respiratory infections and COPD
Chronic respiratory diseases pose a major public health problem, with an estimated 3.9 million deaths in 2017, accounting for 7% of all deaths worldwide. Chronic obstructive pulmonary disease (COPD) caused most of these deaths.
Infant lower respiratory tract infections have been shown to be linked to the development of adult lung function impairments, asthma, and chronic obstructive pulmonary disease, but it was previously unclear if there exists a link to premature death in adulthood. This new research is the first lifetime-spanning study on this topic, providing the best evidence yet to suggest that early respiratory health has an impact on mortality later in life.
Dr James Allinson, Imperial College London, UK and lead author of the study, said: “Current preventative measures for adult respiratory disease mainly focus on adult lifestyle risk factors such as smoking. Linking one in five of adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.
“To prevent the perpetuation of existing adult health inequalities we need to optimise childhood health, not least by tackling childhood poverty. Evidence suggesting the early life origins of adult chronic diseases also helps challenge the stigma that all deaths from diseases such as COPD are related to lifestyle factors.”
Efforts needed to reduce childhood respiratory infections
The study uses data from a nationwide British cohort (The National Survey of Health and Development), which recruited individuals at birth in 1946, and looks at health and death records up to the year 2019. Of the 3,589 study participants, 25% (913/3,589) had a lower respiratory tract infection before the age of two. By the end of 2019, 19% (674/3,589) of participants had died before the age of 73 years old. Among these 674 premature adult deaths, 8% (52/674) participants died from respiratory disease, mostly COPD.
Analysis adjusting for socioeconomic background during childhood and smoking status, suggests children who had a lower respiratory tract infection by the age of two were 93% more likely to die prematurely as adults from respiratory disease, than children who had not had a lower respiratory tract infection by age two. This equates to a 2.1% rate of premature adult death from respiratory disease among those who had a lower respiratory tract infection in early childhood, compared to 1.1% among those who did not.
This risk accounts for one in five (20.4%) of premature respiratory-caused adult deaths, corresponding to 179,188 excess deaths from respiratory diseases across England and Wales between 1972 and 2019. In comparison adult respiratory deaths attributable to smoking account for three in five of deaths (57.7%) from respiratory disease in England and Wales over the same period (507,223 out of 878,951 deaths).
Having a lower respiratory infection before the age of two was only associated with an increased risk of premature death from respiratory diseases, and not other illnesses, such as heart disease or cancers.
Professor Rebecca Hardy, Loughborough University and University College London, added: “The results of our study suggest that efforts to reduce childhood respiratory infections could have an impact on tackling premature mortality from respiratory disease later in life. We hope that this study will help guide the strategies of international health organisations in tackling this issue.”