title: Contribution of respiratory tract infections to child deaths: a data linkage study.
abstract: BACKGROUND
  Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified.
  
  
  METHODS
  We analysed deaths in children resident in England who died of non-injury causes aged 28 days to 18 years between 2001 and 2010 using death certificates linked to a longitudinal hospital admission database. We defined deaths as RTI-related if RTIs or other respiratory conditions were recorded on death certificates or linked hospital records up to 30 days before death. We examined trends in mortality by age group, year and season (winter or summer) and determined the winter excess of RTI-related deaths using rate differencing techniques. We estimated the proportion of RTI-related deaths in children with chronic conditions.
  
  
  RESULTS
  22.4% (5039/22509) of child deaths were RTI-related. RTI-related deaths declined by 2.3% per year in infants aged 28 to 364 days between 2001 and 2010. No decline was observed for older children. On average there were 161 winter excess RTI-related deaths annually, accounting for 32% of all RTI-related deaths. 89.0% of children with RTI-related deaths had at least one chronic condition; neurological conditions were the most prevalent.
  
  
  CONCLUSIONS
  RTI-related deaths have not declined in the last decade except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. p.hardelid@ucl.ac.uk.
authors.forename: Pia
authors.initials: P
authors.lastname: Hardelid
authors.forename: Nirupa
authors.initials: N
authors.lastname: Dattani
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: Ruth
authors.initials: R
authors.lastname: Gilbert
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003625:Data Collection; D003644:Death Certificates; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000401:mortality*; D012621:Seasons; D013222:State Medicine