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Gestational Age at Birth and Hospitalizations for Infections Among Individuals Aged 0 to 50 Years: A Population-Based Study of 2·5 Million Individuals
24 Pages Posted: 13 Apr 2023
More...Abstract
Background: Preterm birth is associated with increased risk of childhood infections. However, whether this risk persists into adulthood is unknown, and limited information is available on risk patterns across the full range of gestational ages.
Methods: We linked individual-level data on all subjects born in Norway (1967-2016) to nationwide hospital data (2008-2017). Gestational age was categorised as 23-27, 28-31, 32-33, 34-36, 37-38, 39-41, and 42-44 completed weeks. The analyses were stratified by age at follow-up: 0-11 months and 1-5, 6-14, 15-29, and 30-50 years. Adjusted hospitalization rate ratios (RRs) were estimated using negative binomial regression for inpatient hospitalization caused by any infection and infection groups.
Findings: Among 2,485,445 individuals with 313,914 hospitalizations for infections, we found a pattern of higher hospitalization risk in lower gestational age groups, which was the strongest in childhood but still evident in adulthood. Comparing those born very preterm (28-31) and late preterm (34-36) to full-term (39-41 weeks), RRs (95% confidence interval) for hospitalization for any infectious disease at ages 1-5 were 3·3 (3·0-3·7) and 1·7 (1·6-1·8), respectively. At 30-50 years, the corresponding estimates were 1·4 (1·2-1·7) and 1·2 (1·1-1·3). The patterns were also similar for the infectious disease groups, including bacterial and viral infections, respiratory tract infections (RTIs), and infections not attributable to RTIs.
Interpretation: Increasing risk of hospitalizations for infections in lower gestational age groups was most prominent in children but still evident in adolescents and adults. Possible mechanisms and effective prevention strategies should be investigated.
Funding: This study was supported by the joint research committee of St. Olavs University Hospital and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (grant no. 30223), Norwegian research council (grant no. 295989), Liaison Committee for education, research and innovation in Central Norway (grant no. 28404), European Commission (grant no. 733280), Academy of Finland, Sigrid Juselius Foundation, Foundation for Pediatric Research, Signe and Ane Gyllenberg Foundation.
Declaration of Interest: The authors declare no competing interests.
Ethical Approval: The study and data linkage were approved by the Regional Committee for Medical and Health Research (Rek-Midt 2018/32) and the registry-keeping authorities.
Keywords: gestational age, preterm, premature birth, infection, infection risk, hospitalization risk, respiratory tract infection, viral infection, bacterial infection
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