174610 School of Public Health, Brown University, Providence, RI, USA.
Division of Infectious Diseases and Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, RI, USA.
Public Health Rep. 2020 Nov/Dec;135(6):771-777. doi: 10.1177/0033354920951151. Epub 2020 Aug 27.
Health disparities are associated with poor outcomes related to public health. The objective of this study was to assess health disparities associated with influenza infection based on median household income and educational attainment.
We geocoded people with documented confirmed influenza infection by home address to identify the US Census 2010 tract in which they lived during 4 influenza surveillance seasons (2013-2014, 2015-2016, 2016-2017, and 2017-2018) in Rhode Island. We dichotomized influenza as severe if the person with influenza infection was hospitalized (ie, inpatient) or as nonsevere if the person was not hospitalized (ie, outpatient). We examined 2 socioeconomic factors: median household income (defined as low, medium low, medium high, and high) and educational attainment (defined as a ratio among people who completed <high school, high school, some college, or ≥bachelor's degree). We calculated relative rates (RRs) to determine the associated level of risk for each socioeconomic factor.
The incidence of influenza per 100 000 person-years was significantly higher in populations with low vs high median household income (620 vs 303; < .001) and in populations with low vs high educational attainment (583 vs 323; < .001). The RR of a severe infection in the quartile with the lowest educational attainment (0.57) was significantly higher than the RR in the other 3 quartiles of educational attainment (range, 0.36-0.39; = .01). However, the RR of a severe infection was higher in the 3 quartiles of median household income (range, 0.38-0.40) than in the quartile with the lowest median household income (0.29).
People in Rhode Island with a lower socioeconomic status are at greater risk of an influenza infection than people with higher socioeconomic status. The reasons for these disparities require further investigation.
健康差距与公共卫生相关的不良结局有关。本研究的目的是根据家庭收入中位数和受教育程度评估与流感感染相关的健康差距。
我们根据家庭住址对有记录的确诊流感感染患者进行地理编码，以确定他们在罗德岛四个流感监测季节（2013-2014 年、2015-2016 年、2016-2017 年和 2017-2018 年）期间居住的美国人口普查 2010 年小区。如果流感感染者住院（即住院患者），我们将流感分为严重病例；如果感染者未住院（即门诊患者），我们将流感分为非严重病例。我们检查了两个社会经济因素：家庭收入中位数（分为低、中低、中高和高）和受教育程度（定义为完成 <高中、高中、大专或≥本科的人数比例）。我们计算了相对比率（RR），以确定每个社会经济因素的相关风险水平。
每 100000 人年的流感发病率在家庭收入中位数较低的人群中明显高于家庭收入中位数较高的人群（620 比 303；<.001），在受教育程度较低的人群中明显高于受教育程度较高的人群（583 比 323；<.001）。受教育程度最低四分位数的严重感染 RR（0.57）明显高于其他 3 个受教育程度四分位数（范围，0.36-0.39；=.01）。然而，家庭收入中位数 3 个四分位数的严重感染 RR（范围，0.38-0.40）高于家庭收入中位数最低四分位数（0.29）。
罗德岛社会经济地位较低的人感染流感的风险高于社会经济地位较高的人。这些差距的原因需要进一步调查。
