Keywords:
Acute respiratory infections; hospitalisation; infant; international comparison; population; record linkage; socioeconomic disparity
Abstract:
OBJECTIVES: Acute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland.
DESIGN: Retrospective population-based cohort studies using linked birth, death and hospitalisation data.
SETTING AND PARTICIPANTS: Population birth cohorts spanning 2000-2012 (Western Australia and Scotland) and 2003-2012 (England).
OUTCOME MEASURES: ARI hospitalisations in infants (<12 months) and children (1-4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends.
RESULTS: The overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1-4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia; 1.9 (1.7 to 2.1) for England; 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation.
CONCLUSIONS: Admissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.