Childhood hospitalisation with infection and cardiovascular disease in early-mid adulthood: a longitudinal population-based study.
BACKGROUND
Pathogen-specific and overall infection burden may contribute to atherosclerosis and cardiovascular disease (CVD), but the effect of infection severity and timing is unknown. We investigated whether childhood infection-related hospitalisation (IRH, a marker of severity) was associated with subsequent adult CVD hospitalisation.


METHODS
Using longitudinal population-based statutorily-collected administrative health data from Western Australia (1970-2009), we identified adults hospitalised with CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) and matched them (10:1) to population controls. We used Cox regression to assess relationships between number and type of childhood IRH and adulthood CVD hospitalisation, adjusting for sex, age, Indigenous status, socioeconomic status, and birth weight.


RESULTS
631 subjects with CVD-related hospitalisation in adulthood (≥ 18 years) were matched with 6310 controls. One or more childhood (< 18 years) IRH was predictive of adult CVD-related hospitalisation (adjusted hazard ratio, 1.3; 95% CI 1.1-1.6; P < 0.001). The association showed a dose-response; ≥ 3 childhood IRH was associated with a 2.2 times increased risk of CVD-related hospitalisation in adulthood (adjusted hazard ratio, 2.2; 95% CI 1.7-2.9; P < 0.001). The association was observed across all clinical diagnostic groups of infection (upper respiratory tract infection, lower respiratory tract infection, infectious gastroenteritis, urinary tract infection, skin and soft tissue infection, and other viral infection), and individually with CVD diagnostic categories (ischaemic heart disease, ischaemic stroke and peripheral vascular disease).


CONCLUSIONS
Severe childhood infection is associated with CVD hospitalisations in adulthood in a dose-dependent manner, independent of population-level risk factors.
Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; School of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
David P
DP
Burgner
Division of Population Sciences, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.
Matthew N
MN
Cooper
Division of Population Sciences, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.
Hannah C
HC
Moore
School of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia.
Fiona J
FJ
Stanley
Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Medicine and Pharmacology and Population Health, University of Western Australia, Crawley, Western Australia, Australia.
Peter L
PL
Thompson
Division of Population Sciences, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.
Nicholas H
NH
de Klerk
McCusker Charitable Foundation Bioinformatics Centre, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.
Kim W
KW
Carter
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors