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Risk factors and viruses associated with hospitalization due to lower respiratory tract infections in Canadian Inuit children: a case-control study

Banerji A, Greenberg D, White LF, Macdonald WA, Saxton A, Thomas E, Sage D, Mamdani M, Lanctôt KL, Mahony JB, Dingle M, Roberts A. Pediatr Infect Dis J. 2009; 28(8):697-701.

Objectives — To examine risk factors for lower respiratory tract infections (LRTI) hospital admission in the Canadian Arctic.

Methods — This was a case-control study during a 14-month period among children less than 2 years of age. Cases were admitted to the Baffin Regional Hospital in Iqaluit, Nunavut with LRTI. Controls were age matched and came from Iqaluit and 2 communities. Odds ratios (ORs) of hospital admission for LRTI were estimated through multivariate conditional logistic regression modeling for following risk factors: smoking in pregnancy, Inuit race, prematurity, adoption status, breast-feeding, overcrowding, and residing outside of Iqaluit. Viruses in nasophayngeal aspirates were sought at the time of each hospital admission.

Results — There were 101 age-matched cases and controls. The following risk factors were significantly associated with an increased risk of admission for LRTI (adjusted OR): smoking in pregnancy (OR = 4.0; 95% CI: 1.1–14.6), residence outside of Iqaluit (OR = 2.7; 95% CI: 1.0–7.2), full Inuit race (OR = 3.8; 95% CI: 1.1–12.8), and overcrowding (OR = 2.5, 95% CI: 1.1–6.1). Non–breast-fed children had a 3.6-fold risk of being admitted for LRTI (95% CI: 1.2–11.5) and non–breast-fed adopted children had a 4.4-fold increased risk (95% CI: 1.1–17.6) when compared with breast-fed, nonadopted children. Prematurity was not associated with an increased risk of admission. Viruses were identified in 88 (72.7%) of admissions, with respiratory syncytial virus being identified in the majority of admissions, 62 (51.2%). Multiple viruses were isolated in 19 (15.7%) admissions.

Conclusions — Smoking during pregnancy, place of residence, Inuit race, lack of breast-feeding, and overcrowding were all independently associated with increased risk of hospital admission for LRTI among Inuit children less than 2 years of age. Future research on the role of adoption and genetics on the health of Inuit children are required.

Keywords: Viral infections Pediatric health Respiratory diseases Hospitalization