Pathways from socioeconomic deprivation to bronchiolitis and subsequent childhood asthma

急性和慢性呼吸道疾病是英国儿童发病的主要原因，并对儿童、其家庭和卫生保健系统造成巨大负担。在婴儿中，肺部感染（细支气管炎）是英格兰最常见的住院原因。哮喘是另一种在英国儿童中非常普遍的呼吸系统疾病。尽管广泛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。讨论集中在直接因果关系或遗传预定信号解释来解释这种关系，而没有充分考虑其他风险因素的作用。这两种情况的一个最重要的方面是社会经济群体之间流行率的不平等。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，这是由于子宫内常见的危险因素，如烟草烟雾暴露、胎儿生长和早产。因此，重要的是，由于大多数这些疾病没有治愈方法，我们必须充分了解导致这些健康问题发生的原因。这对于那些处于社会弱势的儿童尤其重要，他们更容易患上这些疾病和其他慢性疾病。本项目的总体目标是了解社会经济贫困与儿童早期和中期呼吸系统疾病之间的因果关系（见图1）。我将主要使用国家英语和苏格兰出生队列，从行政健康记录创建，以满足特定的研究目标：1。描述社会经济剥夺、季节性和婴儿期急性呼吸道感染之间的关系。确定母亲和围产期风险因素（包括宫内污染暴露、分娩方式、出生体重、胎龄和慢性疾病）在多大程度上介导了社会经济贫困与婴儿期急性呼吸道感染之间的关联。描述10岁以下儿童的哮喘/喘鸣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/喘鸣表型影响的总贡献。 总的来说，我将确定在什么时候，针对哪些风险因素，干预措施将减少儿童呼吸系统疾病的最不公平和总体负担。

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.