Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Influenza Other Respir Viruses. 2013 Nov;7(6):1350-60. doi: 10.1111/irv.12121. Epub 2013 May 13.
Laboratory-confirmed deaths grossly underestimate influenza mortality burden, so that reliable burden estimates are derived from indirect statistical studies, which are scarce in low- and middle-income settings.
Here, we used statistical excess mortality models to estimate the burden of seasonal and pandemic influenza in China.
We modeled data from a nationally representative population-based death registration system, combined with influenza virological surveillance data, to estimate influenza-associated excess mortality for the 2004-2005 through 2009-2010 seasons, by age and region.
The A(H1N1) pandemic was associated with 11·4-12·1 excess respiratory and circulatory (R&C) deaths per 100,000 population in rural sites of northern and southern China during 2009-2010; these rates were 2·2-2·8 times higher than those of urban sites (P<0·01). Influenza B accounted for a larger proportion of deaths than pandemic A(H1N1) in 2009-2010 in some regions. Nationally, we attribute 126,200 (95% CI, 61,000-248,400) excess R&C deaths (rate of 9·4/100,000) and 2,323,000 (1,166,000-4,533,000) years of life lost (YLL) to the first year of A(H1N1)pdm circulation.
The A(H1N1) pandemic posed a mortality and YLL burden comparable to that of interpandemic influenza in China. Our high burden estimates in rural areas highlight the need to enhance epidemiological surveillance and healthcare services, in underdeveloped and remote areas.
实验室确诊的死亡人数严重低估了流感的死亡负担，因此可靠的负担估计来自间接的统计研究，而在中低收入国家和地区，这种研究很少。
本研究采用统计超额死亡率模型估计中国季节性流感和大流行性流感的负担。
我们对基于人群的全国代表性死亡登记系统的数据进行建模，结合流感病毒学监测数据，按年龄和地区估计了 2004-2005 年至 2009-2010 年季节中与流感相关的超额死亡人数。
在 2009-2010 年，甲型 H1N1 大流行在中国北方和南方农村地区与每 10 万人中 11.4-12.1 例呼吸和循环（R＆C）超额死亡相关；这些比率比城市地区高 2.2-2.8 倍（P<0.01）。在某些地区，2009-2010 年乙型流感导致的死亡人数多于大流行 A（H1N1）。在全国范围内，我们将 126200 例（95%CI，61000-248400）R＆C 超额死亡（发生率为 9.4/100000）和 232.3 万（116.6 万-453.3 万）人年生命损失（YLL）归因于 A（H1N1）pdm 循环的第一年。
甲型 H1N1 大流行在中国造成的死亡和 YLL 负担与流感流行期间的负担相当。我们在农村地区的高负担估计值突显了在欠发达和偏远地区加强流行病学监测和医疗保健服务的必要性。
