RTI Health Solutions, Research Triangle Park, NC 27709, USA.
J Med Econ. 2013;16(2):264-77. doi: 10.3111/13696998.2012.752376. Epub 2012 Dec 4.
The objective was to review the published literature on seasonal influenza to assess the differences between complications and mortality rates for those adults at high risk of influenza complications, including the resource use of those hospitalized with influenza complications.
A targeted literature review was performed using electronic database keyword searches, specific inclusion criteria, quality rating of the reviewed full-text articles and abstraction of data to present published evidence on the incidence, complication rates and health service use associated with clinical influenza in different adult high-risk groups including those who are aged 65 years and older or those with different chronic underlying medical conditions.
Key findings for incidence rates of clinical influenza were that incidence rates are similar among people with chronic cardiovascular or respiratory comorbidity, and may be higher in those with allogeneic stem cell transplants compared to those with autologous transplants. Rates of hospitalization and/or pneumonia or lower respiratory tract infection for those with chronic conditions or those who are immunocompromised are substantially higher than those in people over age 65 but without additional high-risk factors. A person who is hospitalized and has a laboratory-confirmed influenza diagnosis has a probability of intensive care unit admission of between 11.8-28.6% and of death of between 2.9-14.3%.
These findings indicate that although the burden of influenza varied across high-risk groups, it also varied widely across studies within a single high-risk group. A key finding was that those over 65 years of age but without additional high-risk factors had a low risk of influenza complications. A limitation of the review is that most of the studies of hospitalized patients did not present outcomes data separately by high-risk group and only limited data were identified on rates of hospitalization or lower respiratory tract infection for most high-risk groups. Information about influenza complication rates and resource use, including influenza vaccines, chemoprophylaxis and/or treatment strategies for different high-risk groups, is needed to evaluate new interventions.
本研究旨在回顾已发表的季节性流感文献，评估流感并发症高危人群（包括因流感并发症住院的人群）的并发症和死亡率差异，并评估相关资源的利用情况。
采用电子数据库关键词搜索，结合特定纳入标准、对全文文章进行质量评分以及提取数据的方法，对不同成年高危人群（包括年龄≥65 岁或患有不同慢性基础疾病的人群）临床流感相关发病率、并发症发生率和卫生服务利用的已发表证据进行综述。
临床流感发病率的主要发现是，患有慢性心血管或呼吸系统合并症的人群发病率相似，异基因干细胞移植患者的发病率可能高于自体移植患者。患有慢性疾病或免疫功能低下的人群，其住院和/或肺炎或下呼吸道感染的发生率远高于无其他高危因素的年龄≥65 岁人群。住院且实验室确诊流感的患者入住重症监护病房的概率为 11.8%至 28.6%，死亡率为 2.9%至 14.3%。
这些发现表明，虽然流感在不同高危人群中的负担不同，但在单一高危人群内的不同研究中也存在很大差异。一个关键发现是，年龄≥65 岁但无其他高危因素的人群流感并发症风险较低。本综述的局限性在于，大多数住院患者研究未按高危人群分别呈现结局数据，并且仅确定了大多数高危人群的住院或下呼吸道感染发生率的有限数据。需要有关不同高危人群流感并发症发生率和资源利用（包括流感疫苗、化学预防和/或治疗策略）的信息，以评估新的干预措施。
