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Epidemiological perspectives of acute lo Epidemiological perspectives of acute lo... - Complex Object ()
Epidemiological perspectives of acute lower respiratory infections in young Western Australian Aboriginal and non-Aboriginal children / Hannah Catherine Moore
[Truncated abstract] Background and Objectives. Acute lower respiratory infections (ALRI), predominantly of viral origin, are a major cause of paediatric morbidity in developed countries. This thesis aimed to broaden the knowledge of ALRI epidemiology in Aboriginal and non-Aboriginal children in Australia, specifically Western Australia (WA), by examining the age-specific trends in incidence over time, risk factors and aetiological aspects using a variety of data sources and statistical methods. Methods. Using the unique Western Australian Data Linkage System, a retrospective populationbased data linkage cohort study of singleton live births between 1996 and 2005 in WA was undertaken. Hospitalisations for ALRI in Aboriginal and non-Aboriginal children up to the age of 9 years were extracted and grouped according to specific ALRI diagnoses. Trends in age-specific incidence rates were examined by log-linear modeling using negative binomial regression and population attributable fractions (PAF) of known maternal and infant risk factors for hospitalisation with ALRI were calculated using multiple logistic regression. To examine the aetiology of ALRI, three datasets were used. First, data were extracted on respiratory viruses identified in nasopharyngeal or throat specimens collected between 1997 and 2005 at WA’s only paediatric hospital in metropolitan Perth. Binomial regression incorporating harmonic analysis was used to examine the variations in seasonality of RSV, influenza viruses A and B, parainfluenza viruses types 1-3 and adenoviruses with Aboriginality and age. Secondly, statewide laboratory data were linked to hospitalisations for ALRI between 2000 and 2005 among children in the retrospective birth cohort to investigate age-specific identification rates of respiratory viruses and bacteria from ALRI hospitalisations.
Finally, the identification of viruses alone and in combination with Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae from nasopharyngeal aspirates collected from healthy children was determined. These data from a longitudinal community-based cohort study in rural WA were analysed by logistic regression models incorporating generalized estimating equations. Results. From the retrospective cohort of 245, 249 births, of which 7.1% (17,466) identified as Aboriginal, there were 26,106 episodes of ALRI. The overall admission rate was 16.1/1000 person-years for non-Aboriginal children and 93.0/1000 person-years for Aboriginal children. Bronchiolitis accounted for 45.9% of ALRI episodes while pneumonia accounted for 29.6%. Between 1996-2000 and 2001-2005 all-cause pneumonia hospitalisations fell in Aboriginal children aged 6-35 months with no equivalent decline in non-Aboriginal children, partly attributable to the introduction of pneumococcal conjugate vaccine. The disparity for pneumonia between Aboriginal and non-Aboriginal children declined by a third...
Thesis (Ph.D.)--University of Western Australia, 2011
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