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Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study
  1. Maximiliane L Verfürden1,
  2. Ruth Gilbert1,
  3. Neil Sebire4,
  4. Pia Hardelid1
  1. 1 Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
  2. 4 Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
  1. Correspondence to Maximiliane L Verfürden, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; m.verfuerden{at}


Objective To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.

Design Whole-country, birth cohort study using linked administrative health databases from Scotland.

Setting and participants Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.

Main outcome measures Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2–11 months and at 1–4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.

Results The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2–11 months: HR 68.48, 95% CI (40.57 to 115.60), 1–4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2–11 months: HR 2.42, 95% CI (1.67 to 3.63), 1–4 years: HR 2.53, 95% CI (1.36 to 4.71)).

Conclusions The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures.

  • avoidable mortality
  • chronic conditions
  • administrative data
  • respiratory mortality
  • sudden unexplained death

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  • Contributors MLV, RG, NS and PH conceptualised the study. MLV carried out the data cleaning and analyses and drafted the manuscript. PH oversaw data analyses and all authors critically reviewed the manuscript and contributed to editing the final manuscript. PH and RG negotiated access to data sources. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding MLV, PH and RG were supported by funding from the Department of Health Policy Research Programme through funding to the Policy Research Unit in the Health of Children, Young People and Families (grant reference number 109/0001). This article represents independent research funded by the Department of Health. The study benefitted from infrastructure and academic support at the Farr Institute of Health Informatics Research London and the ADRC-E: Administrative Data Research Centre-England. ESRC funded–Ref ES/L007517/1.

  • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Public Benefit and Privacy Panel for Health and Social Care (Reference No 1516-0405) and the Privacy Advisory Committee (No XRB13020)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Sharing of the raw data used for this study is not allowed under agreements with the data providers, due to the possibility of individual disclosure.

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