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. 2017 Nov;11(6):479-488.
doi: 10.1111/irv.12483. Epub 2017 Oct 6.

Social determinants of influenza hospitalization in the United States

Rameela Chandrasekhar  1 , Chantel Sloan  2 , Edward Mitchel  1 , Danielle Ndi  1 , Nisha Alden  3 , Ann Thomas  4 , Nancy M Bennett  5 , Pam D Kirley  6 , Mary Hill  7 , Evan J Anderson  8 , Ruth Lynfield  9 , Kimberly Yousey-Hindes  10 , Marisa Bargsten  11 , Shelley M Zansky  12 , Krista Lung  13 , Monica Schroeder  14 , Maya Monroe  15 , Seth Eckel  16 , Tiffanie M Markus  1 , Charisse N Cummings  17 , Shikha Garg  17 , William Schaffner  1 , Mary Lou Lindegren  1
Affiliations

Social determinants of influenza hospitalization in the United States

Rameela Chandrasekhar et al. Influenza Other Respir Viruses. 2017 Nov.

Abstract

Background: Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract-based socioeconomic determinants beyond the effect of individual factors.

Objective: To evaluate whether census tract-based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual-level determinants.

Methods: We analyzed 33 515 laboratory-confirmed influenza-associated hospitalizations that occurred during the 2009-2010 through 2013-2014 influenza seasons using a population-based surveillance system at 14 sites across the United States.

Results: Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72-9.70) for those ≥65 vs 5-17 years old. African Americans had an AOR of 1.67 (95% CI 1.60-1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16-1.26) compared to non-Hispanics. Among census tract-based determinants, those living in a tract with ≥20% vs <5% of persons living below poverty had an AOR of 1.31 (95% CI 1.16-1.47), those living in a tract with ≥5% vs <5% of persons living in crowded conditions had an AOR of 1.17 (95% CI 1.11-1.23), and those living in a tract with ≥40% vs <5% female heads of household had an AOR of 1.32 (95% CI 1.25-1.40).

Conclusion: Census tract-based determinants account for 11% of the variability in influenza hospitalization.

Keywords: census tract-based determinants; disparities; geocoding; influenza hospitalization; multilevel modeling; socioeconomic determinants.

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Figures

Figure 1
Figure 1
Flowchart of inclusions and exclusions of influenza hospitalization cases 2009‐2010 through 2013‐2014 from 14 sites
Figure 2
Figure 2
Crude annual influenza hospitalization incidence rate per 100 000 persons by site. The study population includes influenza hospitalization cases 2009‐2010 through 2013‐2014 from 14 sites
Figure 3
Figure 3
Age‐standardized influenza hospitalization incidence rates by site and census tract‐based determinants (A‐F). The study population includes influenza hospitalization cases 2009‐2010 through 2013‐2014 from 14 sites
Figure 4
Figure 4
Age‐standardized influenza hospitalization incidence rates by site and individual factors (A‐D). The study population includes influenza hospitalization cases 2009‐2010 through 2013‐2014 from 14 sites
Figure 5
Figure 5
Forest plots displaying adjusted odds ratio and its associated 95% confidence intervals for the subset of cases that had positive indicators for asthma (A), underlying conditions (B), vaccination (C), and no vaccination (D). The study population includes influenza hospitalization cases 2009‐2010 through 2013‐2014 from 14 sites
See this image and copyright information in PMC

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