Age-related trends in the timeliness and prediction of medical visits, hospitalizations and deaths due to pneumonia and influenza, British Columbia, Canada, 1998-2004

Abstract

The influenza immunization program in North America has been primarily designed to provide direct benefit to vaccinated individuals at highest risk of serious influenza outcomes. Some evidence suggests that immunization of certain age groups may also extend indirect protective benefit to vulnerable populations. Our goal was to identify age groups associated earliest with seasonal influenza activity and who may have the greatest indirect impact at the population level. We examined age-based associations between influenza medical visits and population-wide hospitalization/mortality due to pneumonia & influenza (P&I) using administrative datasets in British Columbia, Canada. A peak week was identified for each age group based on the highest rates observed in a given week for that study year. Mean rates at the peak week were averaged over the study years per age group. Timeliness (T) was defined as the mean difference in days between the first peak in influenza medical visits and population-wide P&I hospitalizations/deaths. Poisson regression was applied to calculate prediction (Pr) as the average proportion of deviance in P&I explained by influenza medical visits. T and Pr were derived by age group, and the product (T x Pr) was used as a summary measure to rank potential indirect effects of influenza by age group. Young children (0-23 months) and the elderly (> or = 65 years) had the highest peak rates of P&I hospitalization. Children < 6m and the elderly had the highest peak rates of P&I mortality. We found no significant differences by age for influenza medical visits in predicting population-wide P&I hospitalizations or deaths. School-aged children (5-19 years) showed the best relative combination of T x Pr, followed by preschool-aged children (2-4 years). We conclude that the very young and old suffer the greatest morbidity due to P&I, and an indirect role for school-aged children in anticipating the risk to others warrants further evaluation.

Figure 1

(a) Seasonal distribution of percent of all visits due to influenza-like illness (ILI) among sentinel physicians, 1998–1999 to 2003–2004 and (b) seasonal distribution of influenza medical visits in British Columbia, 1998–1999 to 2003–2004.

Figure 2

Prediction and timeliness of influenza medical visits by age group in signaling overall P&I hospitalizations, 1998–1999, 1999–2000, 2000–2001, and 2003–2004.