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. 2012 Aug;102(8):e51-8.
doi: 10.2105/AJPH.2012.300814. Epub 2012 Jun 14.

The social determinants of health and pandemic H1N1 2009 influenza severity

Elizabeth C Lowcock  1 , Laura C Rosella, Julie Foisy, Allison McGeer, Natasha Crowcroft
Affiliations

The social determinants of health and pandemic H1N1 2009 influenza severity

Elizabeth C Lowcock et al. Am J Public Health. 2012 Aug.

Abstract

Objectives: We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations.

Methods: We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada.

Results: During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association.

Conclusions: The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.

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Figures

FIGURE 1—
FIGURE 1—
A conceptual model of the association between the social determinants of health and severe H1N1 illness: Pandemic H1N1 Case-Control Study, Ontario, Canada, April 23–November 6, 2009. Note. BMI = body mass index (defined as weight in kilograms divided by the square of height in meters). Figure shows overall association between social determinants of health measures and severe infection (A). Previously identified clinical risk factors for severe disease may lie on the causal pathway and are potential mediators of the association (B1 and B2).
FIGURE 2—
FIGURE 2—
The relative contributions of mediating risk factors to the associations between social determinants of health and risk of hospitalization: Pandemic H1N1 Case-Control Study, Ontario, Canada, April 23–November 6, 2009. Note. BMI = body mass index (defined as weight in kilograms divided by the square of height in meters). The total height of a bar represents the magnitude of the association between a social determinant of health variable and pandemic H1N1 2009 hospitalization. Each bar is broken down by color or pattern to illustrate the proportion of the association that is mediated by risk factor(s) (see legend), as determined by multivariate logistic regression.
See this image and copyright information in PMC

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