In a study published in The Lancet, researchers sought to assess the correlation between early childhood LRTIs and the risk and burden of premature adult mortality from respiratory disease.

The study was a longitudinal observational cohort study that utilized data compiled prospectively from a nationwide British cohort study called The National Survey of Health and Development, which recruited individuals at birth in March 1946 in England, Scotland, and Wales to explore health and death records for 3,589 individuals until 2019. This first-of-its-kind study covers more than 73 years and provides the best evidence to date that early respiratory health has an impact on mortality later in life.

The researchers assessed the correlation between LRTI during early childhood (ages younger than 2 years) and death from respiratory diseases from age 26 through 73 years.

The researchers applied a statistical model to estimate the correlation between a respiratory infection in early childhood and premature death from respiratory diseases in adulthood while modifying for various factors that can impact risk.

Analysis adjusting for socioeconomic background during childhood and smoking status implied that children who had an LRTI by age 2 years were 93% more likely to die prematurely from respiratory disease as adults compared with children who had not had a LRTI by age 2 years. This finding equated to a 2.1% rate of premature adult death from respiratory disease among those who had an LRTI in early childhood compared with 1.1% among those who did not report a LRTI before age 2 years.

The researchers noted that this augmented risk theoretically accounts for 179,188 premature deaths in England and Wales between 1972 and 2019, or one in five deaths from respiratory disease. In comparison, over the same period, adult respiratory deaths related to a history of smoking account for three in five deaths from respiratory disease, or 507,223 excess deaths in England and Wales.

The researchers mentioned that despite their adjustments, there may have been other risk factors that were unreported, including parental smoking and being born prematurely. Other factors mentioned include that societal changes during the life-spanning study may have led to changes in the lung function of subsequent cohorts and modified outcomes.

In a press release, James Allinson, lead author for the study from the National Heart & Lung Institute at Imperial College London, stated, “Current preventative measures for adult respiratory disease mainly focus on adult lifestyle risk factors such as smoking. Linking one in five adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood. Dr. Allison also stated, “To prevent the perpetuation of existing adult health inequalities, we need to optimize 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.”

“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 organizations in tackling this issue,” stated Rebecca Hardy, coauthor for the study, from University College London and Loughborough University.

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