Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010

A systematic analysis

Harish Nair, Eric A F Simões, Igor Rudan, Bradford D. Gessner, Eduardo Azziz-Baumgartner, Jian Shayne F Zhang, Daniel Feikin, Grant A. MacKenzie, Jennifer C. Moïsi, Anna Roca, Henry C. Baggett, Syed M A Zaman, Rosalyn J. Singleton, Marilla G. Lucero, Aruna Chandran, Angela Gentile, Cheryl Cohen, Anand Krishnan, Zulfiqar A. Bhutta, Adriano Arguedas & 16 others Alexey Wilfrido Clara, Ana Lucia Andrade, Maurice Ope, Raúl Oscar Ruvinsky, María Hortal, John P. McCracken, Shabir A. Madhi, Nigel Bruce, Shamim A. Qazi, Saul S. Morris, Shams El Arifeen, Martin W. Weber, J. Anthony G. Scott, W Abdullah Brooks, Robert F. Breiman, Harry Campbell

Research output: Contribution to journalArticle

Abstract

Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identifi ed 89 eligible studies and estimated that in 2010, 11•9 million (95% CI 10•3-13•9 million) episodes of severe and 3•0 million (2•1-4•2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000-450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.

Original languageEnglish (US)
Pages (from-to)1380-1390
Number of pages11
JournalThe Lancet
Volume381
Issue number9875
DOIs
StatePublished - Apr 2013

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Respiratory Tract Infections
Incidence
Mortality
Disease Management
Hospital Mortality
Infection
Population
Developing Countries
Health Services
Pneumonia
Referral and Consultation
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nair, H., Simões, E. A. F., Rudan, I., Gessner, B. D., Azziz-Baumgartner, E., Zhang, J. S. F., ... Campbell, H. (2013). Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: A systematic analysis. The Lancet, 381(9875), 1380-1390. https://doi.org/10.1016/S0140-6736(12)61901-1

Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010 : A systematic analysis. / Nair, Harish; Simões, Eric A F; Rudan, Igor; Gessner, Bradford D.; Azziz-Baumgartner, Eduardo; Zhang, Jian Shayne F; Feikin, Daniel; MacKenzie, Grant A.; Moïsi, Jennifer C.; Roca, Anna; Baggett, Henry C.; Zaman, Syed M A; Singleton, Rosalyn J.; Lucero, Marilla G.; Chandran, Aruna; Gentile, Angela; Cohen, Cheryl; Krishnan, Anand; Bhutta, Zulfiqar A.; Arguedas, Adriano; Clara, Alexey Wilfrido; Andrade, Ana Lucia; Ope, Maurice; Ruvinsky, Raúl Oscar; Hortal, María; McCracken, John P.; Madhi, Shabir A.; Bruce, Nigel; Qazi, Shamim A.; Morris, Saul S.; Arifeen, Shams El; Weber, Martin W.; G. Scott, J. Anthony; Brooks, W Abdullah; Breiman, Robert F.; Campbell, Harry.

In: The Lancet, Vol. 381, No. 9875, 04.2013, p. 1380-1390.

Research output: Contribution to journalArticle

Nair, H, Simões, EAF, Rudan, I, Gessner, BD, Azziz-Baumgartner, E, Zhang, JSF, Feikin, D, MacKenzie, GA, Moïsi, JC, Roca, A, Baggett, HC, Zaman, SMA, Singleton, RJ, Lucero, MG, Chandran, A, Gentile, A, Cohen, C, Krishnan, A, Bhutta, ZA, Arguedas, A, Clara, AW, Andrade, AL, Ope, M, Ruvinsky, RO, Hortal, M, McCracken, JP, Madhi, SA, Bruce, N, Qazi, SA, Morris, SS, Arifeen, SE, Weber, MW, G. Scott, JA, Brooks, WA, Breiman, RF & Campbell, H 2013, 'Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: A systematic analysis', The Lancet, vol. 381, no. 9875, pp. 1380-1390. https://doi.org/10.1016/S0140-6736(12)61901-1
Nair, Harish ; Simões, Eric A F ; Rudan, Igor ; Gessner, Bradford D. ; Azziz-Baumgartner, Eduardo ; Zhang, Jian Shayne F ; Feikin, Daniel ; MacKenzie, Grant A. ; Moïsi, Jennifer C. ; Roca, Anna ; Baggett, Henry C. ; Zaman, Syed M A ; Singleton, Rosalyn J. ; Lucero, Marilla G. ; Chandran, Aruna ; Gentile, Angela ; Cohen, Cheryl ; Krishnan, Anand ; Bhutta, Zulfiqar A. ; Arguedas, Adriano ; Clara, Alexey Wilfrido ; Andrade, Ana Lucia ; Ope, Maurice ; Ruvinsky, Raúl Oscar ; Hortal, María ; McCracken, John P. ; Madhi, Shabir A. ; Bruce, Nigel ; Qazi, Shamim A. ; Morris, Saul S. ; Arifeen, Shams El ; Weber, Martin W. ; G. Scott, J. Anthony ; Brooks, W Abdullah ; Breiman, Robert F. ; Campbell, Harry. / Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010 : A systematic analysis. In: The Lancet. 2013 ; Vol. 381, No. 9875. pp. 1380-1390.
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abstract = "Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identifi ed 89 eligible studies and estimated that in 2010, 11•9 million (95{\%} CI 10•3-13•9 million) episodes of severe and 3•0 million (2•1-4•2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95{\%} CI 160 000-450 000) in-hospital deaths took place in young children, with 99{\%} of these deaths in developing countries. Therefore, the data suggest that although 62{\%} of children with severe ALRI are treated in hospitals, 81{\%} of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.",
author = "Harish Nair and Sim{\~o}es, {Eric A F} and Igor Rudan and Gessner, {Bradford D.} and Eduardo Azziz-Baumgartner and Zhang, {Jian Shayne F} and Daniel Feikin and MacKenzie, {Grant A.} and Mo{\"i}si, {Jennifer C.} and Anna Roca and Baggett, {Henry C.} and Zaman, {Syed M A} and Singleton, {Rosalyn J.} and Lucero, {Marilla G.} and Aruna Chandran and Angela Gentile and Cheryl Cohen and Anand Krishnan and Bhutta, {Zulfiqar A.} and Adriano Arguedas and Clara, {Alexey Wilfrido} and Andrade, {Ana Lucia} and Maurice Ope and Ruvinsky, {Ra{\'u}l Oscar} and Mar{\'i}a Hortal and McCracken, {John P.} and Madhi, {Shabir A.} and Nigel Bruce and Qazi, {Shamim A.} and Morris, {Saul S.} and Arifeen, {Shams El} and Weber, {Martin W.} and {G. Scott}, {J. Anthony} and Brooks, {W Abdullah} and Breiman, {Robert F.} and Harry Campbell",
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TY - JOUR

T1 - Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010

T2 - A systematic analysis

AU - Nair, Harish

AU - Simões, Eric A F

AU - Rudan, Igor

AU - Gessner, Bradford D.

AU - Azziz-Baumgartner, Eduardo

AU - Zhang, Jian Shayne F

AU - Feikin, Daniel

AU - MacKenzie, Grant A.

AU - Moïsi, Jennifer C.

AU - Roca, Anna

AU - Baggett, Henry C.

AU - Zaman, Syed M A

AU - Singleton, Rosalyn J.

AU - Lucero, Marilla G.

AU - Chandran, Aruna

AU - Gentile, Angela

AU - Cohen, Cheryl

AU - Krishnan, Anand

AU - Bhutta, Zulfiqar A.

AU - Arguedas, Adriano

AU - Clara, Alexey Wilfrido

AU - Andrade, Ana Lucia

AU - Ope, Maurice

AU - Ruvinsky, Raúl Oscar

AU - Hortal, María

AU - McCracken, John P.

AU - Madhi, Shabir A.

AU - Bruce, Nigel

AU - Qazi, Shamim A.

AU - Morris, Saul S.

AU - Arifeen, Shams El

AU - Weber, Martin W.

AU - G. Scott, J. Anthony

AU - Brooks, W Abdullah

AU - Breiman, Robert F.

AU - Campbell, Harry

PY - 2013/4

Y1 - 2013/4

N2 - Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identifi ed 89 eligible studies and estimated that in 2010, 11•9 million (95% CI 10•3-13•9 million) episodes of severe and 3•0 million (2•1-4•2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000-450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.

AB - Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identifi ed 89 eligible studies and estimated that in 2010, 11•9 million (95% CI 10•3-13•9 million) episodes of severe and 3•0 million (2•1-4•2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000-450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.

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