title: Risk factors for hospitalization with lower respiratory tract infections in children in rural Alaska.
abstract: OBJECTIVE
  Lower respiratory tract infections (LRTIs) are a major cause of morbidity for children worldwide and particularly for children from developing and indigenous populations. In this study, we evaluated risk factors for hospitalization with LRTI in a region in southwest Alaska.
  
  
  METHODS
  The study was conducted from October 1, 2006, to September 30, 2007, in the Yukon Kuskokwim Delta region of Alaska. Cases were recruited from children <3 years of age hospitalized with LRTI. Controls were recruited during visits to the surrounding communities in the region and matched posthoc to cases on the basis of subregion, season, and age. Parents were interviewed for potential risk factors, and medical records were reviewed. Participants had a nasopharyngeal swab sample taken for polymerase chain reaction (PCR) testing for a panel of respiratory viruses. Samples positive for respiratory syncytial virus, human metapneumovirus, or parainfluenza type 3 were quantitated by reverse transcriptase real-time quantitative PCR.
  
  
  RESULTS
  One hundred twenty-eight cases were matched to 186 controls. In a multivariable conditional logistic regression model, significantly (P < .05) increased risk of hospitalization was associated with medically high-risk status, having a woodstove in the house, being bottle fed, and vomiting after feeding; living in a house that had 2 or more rooms with sinks was a protective factor. Viral loads in hospitalized cases were significantly higher than those in controls, but a strict cutoff level was not observed.
  
  
  CONCLUSIONS
  Several risk factors for LRTI hospitalization were identified in this high risk population. Some factors are amenable to environmental and behavioral interventions.
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA. lrb2@cdc.gov
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Bulkow
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: Carolynn
authors.initials: C
authors.lastname: DeByle
authors.forename: Karen
authors.initials: K
authors.lastname: Miernyk
authors.forename: Gregory
authors.initials: G
authors.lastname: Redding
authors.forename: Kimberlee Boyd
authors.initials: KB
authors.lastname: Hummel
authors.forename: Lori
authors.initials: L
authors.lastname: Chikoyak
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
mesh_terms: D000413:Alaska; D016022:Case-Control Studies; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011610:Psychosocial Deprivation; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors