Diverging trends for lower respiratory infections in non-Aboriginal and Aboriginal children
Diverging trends for lower respiratory infections in non-Aboriginal and Aboriginal children
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DOI：
10.1111/j.1440-1754.2007.01110.x
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发表时间：
2007-06-01
影响因子：
1.7
通讯作者：
Lehmann, Deborah
中科院分区：
文献类型：
--
作者：
Moore, Hannah;Burgner, David;Lehmann, Deborah
目的：探讨非原住民和原住民儿童出生队列中急性下呼吸道感染（ALRI）入院率的时间趋势。方法：使用西澳大利亚数据链接系统对相关人口数据进行回顾性分析。1990年至2000年间，西澳大利亚州的所有单胎活产都包括在内。调查了2岁前ALRI每1000例活产的住院率和ALRI住院率的线性时间趋势。结果：原住民儿童的ALRI入院率是非原住民儿童的7.5倍（95%可信区间（CI） 7.2-7.7）（337比45 / 1000活产）；肺炎的发生率高13.5倍（95% CI 12.8-14.4），细支气管炎的发生率高5.8倍（95% CI 5.3-6.0）。非原住民儿童ALRI入院率上升（< 12个月，6%/年，P < 0.002； 12-23个月，11%/年，P < 0.001），而12-23个月原住民儿童ALRI入院率下降（4%/年，P = 0.003）。所有儿童的毛细支气管炎发病率均上升，尤其是未满12个月的非土著婴儿（13%/年，P < 0.001），而肺炎发病率在非土著儿童中上升，而在土著儿童中下降。支气管炎和哮喘的发病率也有所下降。结论：12个月前毛细支气管炎的发病率有所增加。对于12-23个月大的儿童，从哮喘和支气管炎到细支气管炎的诊断转变以及卫生服务利用的变化可能解释了时间趋势的差异。土著儿童和非土著儿童之间的持续差异需要得到解决，并且迫切需要适当的预防措施来预防ALRI，特别是细支气管炎。
Aim: To investigate temporal trends in admission rates for acute lower respiratory infections (ALRI) in a total population birth cohort of non-Aboriginal and Aboriginal children.Methods: Retrospective analysis of linked population-based data using the Western Australian Data Linkage System. All singleton live births in Western Australia between 1990 and 2000 were included. Hospital admission rates per 1000 live births for ALRI before age 2 years and linear time trends for ALRI admission rates were investigated.Results: ALRI admission rates were 7.5 (95% confidence interval (CI) 7.2-7.7) times higher in Aboriginal than non-Aboriginal children (337 vs. 45 per 1000 live births); pneumonia rates were 13.5 (95% CI 12.8-14.4) times higher and bronchiolitis rates were 5.8 (95% CI 5.3-6.0) times higher. ALRI admission rates rose in non-Aboriginal children (< 12 months, 6%/year, P < 0.002; 12-23 months, 11%/year, P < 0.001) but declined in Aboriginal children aged 12-23 months (4%/year, P = 0.003). Bronchiolitis rates rose in all children, especially non-Aboriginal infants aged < 12 months (13%/year, P < 0.001), while pneumonia rates rose in non-Aboriginal children but declined in Aboriginal children. Declines in bronchitis and asthma were also noted.Conclusion: There has been an increase in incidence of bronchiolitis before age 12 months. For children aged 12-23 months a diagnostic shift from asthma and bronchitis to bronchiolitis and changes in health service utilisation are likely explanations for diverging temporal trends. The continuing disparity between Aboriginal and non-Aboriginal children needs to be addressed and appropriate preventative measures for ALRI, and in particular bronchiolitis, are urgently needed.