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. 2025 Jun;12(3):1385-1396.
doi: 10.1007/s40615-024-01971-9. Epub 2024 Mar 27.

Influenza-Associated Outcomes and Healthcare Utilization by Race and Ethnicity in the USA: a Retrospective Cohort Study Using the National Inpatient Sample Database

Mohamad El Labban  1 , Wigdan Farah  2 , Perla Mansour  3 , Karine Eid  3 , Yewande E Odeyemi  2
Affiliations

Influenza-Associated Outcomes and Healthcare Utilization by Race and Ethnicity in the USA: a Retrospective Cohort Study Using the National Inpatient Sample Database

Mohamad El Labban et al. J Racial Ethn Health Disparities. 2025 Jun.

Abstract

Background: The influenza virus continues to be a public health concern every season. We aimed to evaluate influenza-associated outcomes and healthcare utilization by race and ethnicity.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample across 2019 and 2020. Influenza pneumonia was selected as the principal diagnosis. Outcomes included mortality, use of respiratory support ventilation, length of stay, and total hospitalization charge. Regression models were adjusted for age, gender, Charlson Comorbidity Index, hospitals' region, bed size, teaching status, insurance status, and median income.

Results: We identified 73,098 individuals hospitalized with influenza pneumonia; 39,807 and 33,291 were admitted in 2019 and 2020, respectively. The sample included 49,829 (68%) White, 11,356 (15.5%) Black, 7526 (10%) Hispanic, 1860 (2.5%) Asian/Pacific, and 617 (0.84%) Native American patients. In-hospital mortality rates and respiratory support (non-invasive ventilation and invasive mechanical ventilation) in 2019 and 2020 were not significantly different across all the races. In 2019 and 2020, the adjusted odds ratios of in-patient mortality were not significantly different. Asians had higher odds of receiving NIV in 2019 but not in 2020 compared to White patients (adjusted odds ratio (aOR) 1.67, p value 0.04). The adjusted odds ratios for receiving IMV were not significantly different between the races in 2019 and 2020.

Conclusions: This study contributes valuable insight into influenza-associated outcomes and healthcare utilization patterns among diverse racial and ethnic groups. Disparities in healthcare utilization were observed among younger (< 65 years) individuals of Black and Hispanic ethnicity.

Keywords: Ethnicity; Health disparity; Hospitalization; Influenza; Mortality; Racial.

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Conflict of interest statement

Declarations. Ethics Approval: The HCUP datasets are publicly available and hence are considered exempt from full or expedited institutional review boards (IRB) review (Federal Regulations 45 CFR 46.101 (b)). Conflict of Interest: The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Influenza pneumonia admissions by race and age group
Fig. 2
Fig. 2
Rates of mortality, NIV, and IMV by race
Fig. 3
Fig. 3
Forest charts of the adjusted odds ratios of outcomes. White was selected as the reference race in the regression model
Fig. 4
Fig. 4
Forest chart: adjusted odds of discharge disposition by race. White was selected as the reference race in the regression model
Fig. 5
Fig. 5
The length of stay and total hospitalization cost by race
See this image and copyright information in PMC

References

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