Trends in death from respiratory illness in children in England and Wales from 1968 to 2000

Jayachandran R Panickar ¹, Susanna R Dodd ², Rosalind L Smyth ³ and Jonathan Michael Couriel ^4*

¹ Royal Liverpool Children's Hospital NHS Trust, Alder Hey, United Kingdom
² Centre for Medical Statistics and Health Evaluation, University of Liverpool, United Kingdom
³ Division of Child Health, University of Liverpool, RLCH NHS Trust, Alder Hey, United Kingdom
⁴ Respiratory Unit, Royal Liverpool Children's Hospital NHS Trust, Alder Hey, United Kingdom

^* To whom correspondence should be addressed. E-mail: jcouriel{at}rlc.nhs.uk.

Accepted 30 August 2005

Abstract

Background: Childhood mortality has decreased markedly over the last three decades. We undertook a study to determine trends in deaths from respiratory illness in children in England and Wales.

Methods: Analysis of mortality data collected by the Office for National Statistics. The data included all deaths registered from all causes in children aged between 28 days and 16 years in England and Wales from 1st January 1968 - 31st December 2000. The main outcome measures were overall and age-specific mortality rates due to all respiratory disorders and specific rates for pneumonia, asthma, cystic fibrosis and bronchiolitis.

Results: In 1-16 year olds, the overall mortality rate (per 100 000 children) declined from 49.9 in 1968 to 16.3 in 2000, and rates due to respiratory illness fell from 8.6 to 1.3. The proportion of all deaths caused by respiratory illness in children aged 28 days- 16 years fell from 30.8% in 1968 to 9.9% in 2000. In post-neonatal infants (aged 28-364 days), the "all causes" mortality rate fell from 592.8 in 1968 to 176 in 2000 and the rates due to respiratory illness fell from 280 to 22.8. In 2000, pneumonia, asthma and cystic fibrosis together accounted for 73% of all respiratory deaths in 1-16 year olds. In this age group, mortality rates per 100,000 for pneumonia fell from 4.22 to 0.57, for asthma from 0.83 to 0.25, and for cystic fibrosis from 0.66 to 0.12, between 1968 and 2000. Over the same period, mortality rates per 100,000 in post-neonatal infants for pneumonia fell from 165 to 6.78 and for CF from 4.88 to 0.33. Bronchiolitis mortality rates per 100,000 in post neonatal infants fell from 21.47 in 1979 to 1.82 in 2000.

Conclusions: Mortality rates due to all respiratory illnesses in children have fallen markedly in the last three decades. This decline has been more rapid than the overall decline in childhood mortality and respiratory diseases are now responsible for a smaller proportion of deaths in children. These data could provide a foundation for assessing the impact on mortality of future health initiatives, such as the introduction of a universal pneumococcal vaccination program to England and Wales.

Keywords: all cause mortality, bronchiolitis and pneumonia, respiratory deaths, asthma, cystic fibrosis

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