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

Social determinants of influenza hospitalization in the United States.

Author information

1
Vanderbilt University School of Medicine, Nashville, TN, USA.
2
Brigham Young University, Provo, UT, USA.
3
Colorado Department of Public Health and Environment, Denver, CO, USA.
4
Oregon Department of Public Health, Portland, OR, USA.
5
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
6
California Emerging Infections Program, Oakland, CA, USA.
7
Salt Lake County Health Department, Salt Lake City, CO, USA.
8
Georgia Emerging Infections Program, Atlanta VAMC, Emory University, Atlanta, GA, USA.
9
Minnesota Department of Health, St. Paul, MN, USA.
10
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA.
11
New Mexico Department of Health, Santa Fe, NM, USA.
12
New York State Department of Health, Albany, NY, USA.
13
Ohio Department of Health, Columbus, OH, USA.
14
Council of State and Territorial Epidemiologists, Atlanta, GA, USA.
15
Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA.
16
Michigan Department of Health and Human Services, Lansing, MI, USA.
17
Influenza Division, CDC, Atlanta, GA, USA.

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

PMID:
28872776
PMCID:
PMC5720587
DOI:
10.1111/irv.12483
[Indexed for MEDLINE]
Free PMC Article

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