Pathways from socioeconomic deprivation to bronchiolitis and subsequent childhood asthma

急性和慢性呼吸系统疾病是英国儿童发病的主要原因，对儿童、家庭和卫生保健系统造成了沉重的负担。在婴儿中，肺部感染（细支气管炎）是英国最常见的住院原因。哮喘是另一种在英国儿童中非常普遍的呼吸系统疾病。尽管人们普遍认为急性呼吸道感染住院与老年哮喘风险增加有关，但关于这种关联的性质仍存在争议。讨论集中在直接病因或遗传预定信号的解释来解释这种关系，而没有充分考虑其他危险因素的作用。这两种情况的一个突出方面是社会经济群体之间患病率的不平等。社会经济地位、婴儿细支气管炎和随后的哮喘之间的关联比例未知，这是由于子宫内的常见危险因素，如烟草烟雾暴露、胎儿生长和早产。因此，重要的是，由于这些疾病中的大多数都无法治愈，我们必须充分了解导致这些健康问题发生的原因。这对已知处于社会不利地位的儿童尤其重要，这些儿童患这些疾病和其他慢性疾病的风险更大。该项目的总体目标是了解儿童早期和中期社会经济剥夺与呼吸条件之间的因果关系（见图1）。我将主要使用国家英格兰和苏格兰出生队列，从行政健康记录创建，以满足具体的研究目标：1。描述婴儿期社会经济剥夺、季节性与急性呼吸道感染之间的关系2。确定包括宫内污染暴露、分娩方式、出生体重、胎龄和慢性病在内的孕产妇和围产期风险因素在多大程度上介导了社会经济剥夺与婴儿急性呼吸道感染之间的关联3。描述10岁以下儿童的哮喘/喘息表型及其相关危险因素，包括社会经济地位4。确定早期急性呼吸道感染对社会经济剥夺对儿童中期哮喘/喘息表型的影响的总贡献。总的来说，我将确定在什么时间，针对哪些风险因素，干预措施将最大程度地减少儿童呼吸道疾病的不平等和总体负担。

Acute and chronic respiratory conditions are a major cause of morbidity amongst children in the UK, and are responsible for substantial burden on children, their families and the health care system. In infants, infection of the lungs (bronchiolitis) is the most common cause of hospitalisation in England. Asthma is another respiratory condition that is highly prevalent amongst children in the UK. Despite wide agreement that hospital admission for acute respiratory infection is associated with an increased risk of asthma at an older age, there is an ongoing debate about the nature of this association. Discussions focus on a directly causative or a genetic predetermined signal explanation to explain this relationship, without fully considering the role of other risk factors. An overriding facet of both conditions is the inequity in prevalence across socioeconomic groups. An unknown proportion of the association between socio-economic status, infant bronchiolitis, and subsequent asthma is due, to common risk factors operating in utero such as tobacco smoke exposure, fetal growth and prematurity. It is therefore important, as there is no cure available for the majority of these conditions, that we fully understand what causes these health problems to occur. This is particularly important amongst children who are known to be socially disadvantaged, and are placed at a greater risk for these diseases and other chronic conditions.The overall aim of this project is to understand the causal pathways between socioeconomic deprivation and respiratory conditions in early and mid-childhood (see Figure 1). I will primarily use national English and Scottish birth cohorts, created from administrative health records, to meet the specific study objectives: 1. To describe the association between socioeconomic deprivation, seasonality and acute respiratory infection in infancy 2. To establish to what extent maternal and perinatal risk factors, including in-utero pollution exposure, mode of delivery, birth weight, gestational age and chronic conditions mediates the association between socioeconomic deprivation and acute respiratory infection in infancy 3. To describe asthma/wheeze phenotypes in children aged <10 years old and their associated risk factors, including socio-economic position 4. To determine the total contribution of early acute respiratory infection to the effect of socio-economic deprivation on mid-childhood asthma/wheeze phenotypes. Overall, I will determine at what time, and for which risk factors, interventions would reduce the most inequity and overall burden of respiratory conditions in childhood.