Department of Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, United States of America ; Sage Analytica, Bethesda, Maryland, United States of America.
PLoS Med. 2013 Nov;10(11):e1001558. doi: 10.1371/journal.pmed.1001558. Epub 2013 Nov 26.
Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries.
We obtained weekly virology and underlying cause-of-death mortality time series for 2005-2009 for 20 countries covering ∼35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%-85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000-249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in persons <65 y. Limitations include lack of representation of low-income countries among single-country estimates and an inability to study subsequent pandemic waves (2010-2012).
We estimate that 2009 global pandemic respiratory mortality was ∼10-fold higher than the World Health Organization's laboratory-confirmed mortality count. Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons <65 y of age occurred, so that many more life-years were lost. The burden varied greatly among countries, corroborating early reports of far greater pandemic severity in the Americas than in Australia, New Zealand, and Europe. A collaborative network to collect and analyze mortality and hospitalization surveillance data is needed to rapidly establish the severity of future pandemics. Please see later in the article for the Editors' Summary.
评估 2009 年甲型 H1N1 流感病毒（H1N1pdm09）的死亡率影响对于优化公共卫生应对未来大流行至关重要。世界卫生组织报告了 18631 例经实验室确诊的大流行死亡病例，但大流行的总死亡负担要高得多。我们通过对多个国家的死亡率数据进行统计建模来估计 2009 年大流行的死亡率负担。
我们获得了 2005-2009 年期间 20 个国家每周的病毒学和潜在死因死亡率时间序列，这些国家覆盖了约 35%的世界人口。我们应用多元线性回归模型来估计每个合作国家的大流行呼吸道死亡率。然后，我们使用这些结果以及十个国家指标在一个多重插补模型中预测所有世界国家的死亡率负担。2009 年最后 9 个月，全球估计有 123000-203000 例大流行呼吸道死亡。大多数（62%-85%）归因于 65 岁以下的人。我们观察到明显的区域异质性，一些美洲国家的死亡率比欧洲高近 20 倍。该模型将 148000-249000 例呼吸道死亡归因于流感在一个平均大流行前季节，其中只有 19%的人年龄<65 岁。限制包括在单一国家估计中缺乏低收入国家的代表性以及无法研究随后的大流行波（2010-2012）。
我们估计 2009 年全球大流行呼吸道死亡率比世界卫生组织的实验室确诊死亡率高出约 10 倍。尽管大流行的死亡率估计与季节性流感相似，但在 65 岁以下人群中死亡率明显上升，因此丧失了更多的预期寿命。各国之间的负担差异很大，证实了早期报告的大流行在美洲的严重程度远远高于澳大利亚、新西兰和欧洲。需要建立一个合作网络来收集和分析死亡率和住院监测数据，以便快速确定未来大流行的严重程度。请稍后在文章中查看编辑摘要。
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