Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. We aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease. This longitudinal observational cohort study used data collected prospectively by the Medical Research Council National Survey of Health and Development in a nationally representative cohort recruited at birth in March, 1946, in England, Scotland, and Wales. We evaluated the association between LRTI during early childhood (age <2 years) and death from respiratory disease from age 26 through 73 years. Early childhood LRTI occurrence was reported by parents or guardians. Cause and date of death were obtained from the National Health Service Central Register. Hazard ratios (HRs) and population attributable risk associated with early childhood LRTI were estimated using competing risks Cox proportional hazards models, adjusted for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and smoking at age 20–25 years. We compared mortality within the cohort studied with national mortality patterns and estimated corresponding excess deaths occurring nationally during the study period. 5362 participants were enrolled in March, 1946, and 4032 (75%) continued participating in the study at age 20–25 years. 443 participants with incomplete data on early childhood (368 [9%] of 4032), smoking (57 [1%]), or mortality (18 [<1%]) were excluded. 3589 participants aged 26 years (1840 [51%] male and 1749 [49%] female) were included in the survival analyses from 1972 onwards. The maximum follow-up time was 47·9 years. Among 3589 participants, 913 (25%) who had an LRTI during early childhood were at greater risk of dying from respiratory disease by age 73 years than those with no LRTI during early childhood (HR 1·93, 95% CI 1·10–3·37; p=0·021), after adjustment for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking. This finding corresponded to a population attributable risk of 20·4% (95% CI 3·8–29·8) and 179 188 (95% CI 33 806–261 519) excess deaths across England and Wales between 1972 and 2019. In this prospective, life-spanning, nationally representative cohort study, LRTI 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. National Institute for Health and Care Research Imperial Biomedical Research Centre, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, Royal Brompton and Harefield Hospitals Charity and Imperial College Healthcare NHS Trust, UK Medical Research Council.

中文翻译：

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英国幼儿期下呼吸道感染和成人因呼吸系统疾病而过早死亡：一项全国出生队列研究

众所周知，儿童早期的下呼吸道感染 (LRTI) 会影响肺部发育和终生肺部健康，但其与成人因呼吸道疾病而过早死亡的关系尚不清楚。我们的目的是评估儿童早期 LRTI 与呼吸系统疾病导致成人过早死亡的风险和负担之间的关联。这项纵向观察队列研究使用了医学研究委员会国家健康与发展调查前瞻性收集的数据，该队列是 1946 年 3 月在英格兰、苏格兰和威尔士出生时招募的具有全国代表性的队列。我们评估了幼儿时期（<2 岁）的 LRTI 与 26 岁至 73 岁期间呼吸系统疾病死亡之间的关联。儿童早期 LRTI 的发生是由父母或监护人报告的。死亡原因和日期是从国家卫生服务中心登记处获得的。使用竞争风险 Cox 比例风险模型估算与幼儿期 LRTI 相关的危险比 (HR) 和人群归因风险，并根据儿童社会经济地位、儿童家庭过度拥挤、出生体重、性别和 20-25 岁时吸烟情况进行调整。我们将研究队列内的死亡率与国家死亡率模式进行了比较，并估计了研究期间全国范围内发生的相应超额死亡人数。1946 年 3 月，共有 5,362 名参与者入组，其中 4,032 名 (75%) 在 20-25 岁时继续参与该研究。排除了 443 名幼儿期（4032 人中的 368 人 [9%]）、吸烟（57 人 [1%]）或死亡率（18 人 [<1%]）数据不完整的参与者。自 1972 年起，生存分析中纳入了 3589 名 26 岁参与者（1840 名 [51%] 男性和 1749 名 [49%] 女性）。最长随访时间为47·9年。在 3589 名参与者中，913 名（25%）在儿童早期患有 LRTI 的人在 73 岁时死于呼吸系统疾病的风险比在儿童早期没有患有 LRTI 的人高（HR 1·93，95% CI 1·10– 3·37；p=0·021)，在调整儿童社会经济地位、儿童家庭过度拥挤、出生体重、性别和成年吸烟后。这一发现对应于 1972 年至 2019 年间英格兰和威尔士的人口归因风险为 20·4% (95% CI 3·8–29·8) 和 179 188 (95% CI 33 806–261 519) 的超额死亡。这项前瞻性、跨生命周期、具有全国代表性的队列研究表明，儿童早期的 LRTI 与成人因呼吸系统疾病而过早死亡的风险几乎增加两倍有关，并占这些死亡的五分之一。国家健康与护理研究所帝国生物医学研究中心、皇家布朗普顿和黑尔菲尔德国家医疗服务 (NHS) 基金会信托、皇家布朗普顿和黑尔菲尔德医院慈善机构以及帝国理工学院医疗保健 NHS 信托、英国医学研究委员会。