Pearce D C, McCaw J M, McVernon J, Mathews J D
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie Street, The University of Melbourne, Victoria 3010, Australia; Faculty of Science & Technology, Federation University Australia, University Drive, Mt Helen, Victoria 3350, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 3, 207 Bouverie Street, The University of Melbourne, Victoria 3010, Australia; Modelling and Simulation, Infection and Immunity Theme, Murdoch Childrens Research Institute, 9th floor, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia; School of Mathematics and Statistics, Level 3, Old Geology South, The University of Melbourne, Victoria 3010, Australia.
Environ Res. 2017 Jul;156:688-696. doi: 10.1016/j.envres.2017.04.024. Epub 2017 May 5.
Seasonal peaks of influenza and cardiovascular disease tend to coincide. Many excess deaths may be triggered by influenza, and the severity of this effect may vary with the virulence of the circulating influenza strain and host susceptibility. We aimed to explore the association between hospital admissions for influenza and/or pneumonia (IP) and acute myocardial infarction (AMI) or ischaemic heart disease (IHD) in Queensland, Australia, taking into account temporal and spatial variation of influenza virus type and subtype in 2007, 2008 and 2009.
This ecological study at Statistical Subdivision level (SSD, n=38) used linked patient-level data. For each study year, Standardized Morbidity Ratios (SMRs) were calculated for hospital admissions with diagnoses of IP, AMI and IHD. We investigated the associations between IP and AMI or IHD using spatial autoregressive modelling, adjusting for socio-demographic factors.
Spatial autocorrelation was detected in SMRs, possibly reflecting underlying social and behavioural risk factors, but consistent with infectious disease spread. SMRs for IP were consistently predictive of SMRs for AMI and IHD when adjusted for socioeconomic status, population density and per cent Indigenous population (coefficient: 0.707, 95% confidence interval (CI): 0.318 - 1.096; 0.553, 0.222 - 0.884; 0.598, 0.307 - 0.888 and 1.017, 0.711 - 1.323; 0.650, 0.342 - 0.958; 1.031, 0.827 - 1.236) in 2007, 2008 and 2009, respectively.
This ecological study provides further evidence that severe respiratory infections may trigger the onset of cardiovascular events, implicating the influenza virus as a contributing factor.
流感和心血管疾病的季节性高峰往往同时出现。许多额外死亡可能由流感引发，且这种影响的严重程度可能因流行的流感毒株的毒力和宿主易感性而有所不同。我们旨在探讨澳大利亚昆士兰州流感和/或肺炎（IP）住院与急性心肌梗死（AMI）或缺血性心脏病（IHD）之间的关联，同时考虑2007年、2008年和2009年流感病毒型别和亚型的时间和空间变化。
这项在统计细分区域水平（SSD，n = 38）开展的生态学研究使用了关联的患者层面数据。对于每个研究年份，计算了诊断为IP、AMI和IHD的住院患者的标准化发病比（SMR）。我们使用空间自回归模型研究了IP与AMI或IHD之间的关联，并对社会人口学因素进行了调整。
在SMR中检测到空间自相关性，这可能反映了潜在的社会和行为风险因素，但与传染病传播一致。在对社会经济地位、人口密度和原住民人口百分比进行调整后，2007年、2008年和2009年IP的SMR始终能预测AMI和IHD的SMR（系数分别为：0.707，95%置信区间（CI）：0.318 - 1.096；0.553，0.222 - 0.884；0.598，0.307 - 0.888和1.017，0.711 - 1.323；0.650，0.342 - 0.958；1.031，0.827 - 1.236）。
这项生态学研究提供了进一步的证据，表明严重的呼吸道感染可能引发心血管事件的发作，这意味着流感病毒是一个促成因素。
