Vanderbilt University School of Medicine, Nashville, TN, USA.
Brigham Young University, Provo, UT, USA.
Influenza Other Respir Viruses. 2017 Nov;11(6):479-488. doi: 10.1111/irv.12483. Epub 2017 Oct 6.
Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract-based socioeconomic determinants beyond the effect of individual factors.
To evaluate whether census tract-based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual-level determinants.
We analyzed 33 515 laboratory-confirmed influenza-associated hospitalizations that occurred during the 2009-2010 through 2013-2014 influenza seasons using a population-based surveillance system at 14 sites across the United States.
Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72-9.70) for those ≥65 vs 5-17 years old. African Americans had an AOR of 1.67 (95% CI 1.60-1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16-1.26) compared to non-Hispanics. Among census tract-based determinants, those living in a tract with ≥20% vs <5% of persons living below poverty had an AOR of 1.31 (95% CI 1.16-1.47), those living in a tract with ≥5% vs <5% of persons living in crowded conditions had an AOR of 1.17 (95% CI 1.11-1.23), and those living in a tract with ≥40% vs <5% female heads of household had an AOR of 1.32 (95% CI 1.25-1.40).
Census tract-based determinants account for 11% of the variability in influenza hospitalization.
每年流感住院都会导致大量发病和死亡。除了个体因素的影响外，人们对流感住院与以普查区为基础的社会经济决定因素之间的关联知之甚少。
评估以普查区为基础的决定因素（如贫困和家庭拥挤）是否会显著增加流感住院的风险，超过个体水平的决定因素。
我们分析了美国 14 个地点的一个基于人群的监测系统在 2009-2010 至 2013-2014 流感季节期间发生的 33515 例经实验室确诊的与流感相关的住院病例。
使用多层次回归模型，我们发现个体因素与流感住院相关，年龄≥65 岁与 5-17 岁相比，调整后的优势比（AOR）最高为 9.20（95%可信区间 8.72-9.70）。非裔美国人与白人相比，AOR 为 1.67（95%可信区间 1.60-1.73），西班牙裔人与非西班牙裔人相比，AOR 为 1.21（95%可信区间 1.16-1.26）。在以普查区为基础的决定因素中，与生活在贫困线以下的人口比例≥20%的普查区相比，生活在贫困线以下的人口比例<5%的普查区的 AOR 为 1.31（95%可信区间 1.16-1.47），与居住在拥挤条件下的人口比例≥5%的普查区相比，居住在拥挤条件下的人口比例<5%的普查区的 AOR 为 1.17（95%可信区间 1.11-1.23），与女性户主比例≥40%的普查区相比，女性户主比例<5%的普查区的 AOR 为 1.32（95%可信区间 1.25-1.40）。
以普查区为基础的决定因素占流感住院变异性的 11%。
