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Risk factors for acute respiratory tract infections in general practitioner patients in The Netherlands: a case-control study

Arianne B van Gageldonk-Lafeber1*, Marianne AB van der Sande1, Marie-Louise A Heijnen12, Marcel F Peeters3, Aad IM Bartelds4 and Berry Wilbrink5

Author Affiliations

1 National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and surveillance, Bilthoven, The Netherlands

2 Netherlands Association for Community Health Services, Utrecht, The Netherlands

3 Regional Laboratory of Public Health, Tilburg, The Netherlands

4 Netherlands Institute for Health Services Research, Utrecht, The Netherlands

5 National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netherlands

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BMC Infectious Diseases 2007, 7:35  doi:10.1186/1471-2334-7-35

Published: 27 April 2007



Acute respiratory tract infections (ARTI) are an important public health problem. Improved identification of risk factors might enable targeted intervention. Therefore we carried out a case-control study with the aim of identifying environmental risk factors for ARTI consultations in the Dutch general population.


A subset of patients visiting their GP in the period of 2000–2003 with an ARTI (cases) and age-matched controls (visiting for other complaints) were included in a case-control study. They were asked to complete a questionnaire about potential risk factors. Conditional logistic regression was used to calculate odds ratio's (OR) and 95% confidence intervals (CI) to estimate the independent effect of potential risk factors.


A total of 493 matched pairs of case and control subjects were enrolled. Exposure to persons with respiratory complaints, both inside and outside the household, was found to be an independent risk factor for visiting a GP with an ARTI (respectively ORadj = 1.9 and ORadj = 3.7). Participants exposed to dampness or mould at home (ORadj=0.5) were significantly less likely to visit their GP. In accordance with the general risk of consultations for ARTI, participants with a laboratory-confirmed ARTI who were exposed to persons with respiratory complaints outside the household were also significantly more likely to visit their GP (ORadj=2.5).


This study confirmed that heterogeneity in the general population as well as in pathogens causing ARTI makes it complicated to detect associations between potential risk factors and respiratory infections. Whereas it may be difficult to intervene on the risk posed by exposure to persons with respiratory complaints, transmission of ARTI in the general population might be reduced by improved hygienic conditions.