健康的社会决定因素与 2009 年甲型 H1N1 流感大流行的严重程度。
The social determinants of health and pandemic H1N1 2009 influenza severity.
机构信息
Department of Surveillance and Epidemiology, Public Health Ontario, Toronto, Ontario, Canada.
出版信息
Am J Public Health. 2012 Aug;102(8):e51-8. doi: 10.2105/AJPH.2012.300814. Epub 2012 Jun 14.
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.
目的
我们探讨了健康的社会决定因素对 2009 年甲型 H1N1 流感严重程度的影响，以及临床危险因素在介导这些关联中的作用。
方法
我们使用多变量逻辑回归和广义估计方程，在加拿大安大略省的一项病例对照研究中，检查了个体和生态层面的健康社会决定因素与因 2009 年甲型 H1N1 流感住院之间的关联。
结果
在第一波大流行期间（2009 年 4 月 23 日至 7 月 20 日），住院与高中或以下学历以及居住在物质或总体贫困程度高的社区有关。我们还观察到在第二阶段（2009 年 8 月 1 日至 11 月 6 日）与教育相关的关联。严重的 2009 年甲型 H1N1 流感的临床危险因素解释了约 39%的观察到的关联。
结论
严重的 2009 年甲型 H1N1 流感的主要临床危险因素仅解释了健康的社会决定因素与住院之间观察到的部分关联，这表明健康的社会决定因素影响 2009 年甲型 H1N1 流感结果的方式超出了临床上公认的危险因素。
Zotero 插件