Risk of winter hospitalisation and death from acute respiratory infections in Scotland: national retrospective cohort study

Ting Shi, Tristan Millington, Chris Robertson, Karen Jeffrey, Srinivasa Vittal Katikireddi , Colin McCowan, Colin R Simpson, Lana Woolford, Luke Daines, Steven Kerr, Ben Swallow, Adeniyi Fagbamigbe, Catalina A Vallejos, David Weatherill, Sandra Jayacodi, Kimberly Marsh, Jim McMenamin, Igor Rudan, Lewis Duthie Ritchie, Tanja MuellerAmanj Kurdi, Aziz Sheikh*, Public Health Scotland and the EAVE II Collaborators

*Corresponding author for this work

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Objectives  We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland.

Design  A population-based retrospective cohort analysis.

Setting  Scotland.

Participants  5.4 million residents in Scotland.

Main outcome measures  Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation.

Results  Between September 1, 2022 and January 31, 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1,759 in children and 20,525 in adults) in Scotland. Compared to the reference group of children aged 6-17 years, the risk of ARI hospitalisation was higher in children aged 3-5 years (aHR=4.55 95%CI (4.11-5.04)). Compared to 25-29 years old, the risk of ARI hospitalisation was highest amongst the oldest adults aged ≥80 years (7.86 (7.06-8.76)). Adults from more deprived areas (most deprived vs least deprived, 1.64 (1.57-1.72)), with existing health conditions (≥5 vs 0 health conditions, 4.84 (4.53-5.18)) or with history of all-cause emergency admissions (≥6 vs 0 previous emergency admissions 7.53 (5.48-10.35)) were at higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children.

Conclusions  Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.
Original languageEnglish
Number of pages15
JournalJournal of the Royal Society of Medicine
VolumeOnline First
Early online date12 Feb 2024
Publication statusE-pub ahead of print - 12 Feb 2024


  • Epidemiology
  • Health informatics
  • Respiratory medicine


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