Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BMC Infect Dis. 2021 Dec 11;21(1):1243. doi: 10.1186/s12879-021-06936-5.
Higher incidence of and risk of hospitalisation and death from Influenza A(H1N1)pdm09 during the 2009 pandemic was reported in ethnic minority groups in many high-income settings including in the United Kingdom (UK). Many of these studies rely on geographical and temporal aggregation of cases and can be difficult to interpret due to the spatial and temporal factors in outbreak spread. Further, it can be challenging to distinguish between disparities in health outcomes caused by variation in transmission risk or disease severity.
We used anonymised laboratory confirmed and suspected case data, classified by ethnicity and deprivation status, to evaluate how disparities in risk between socio-economic and ethnic groups vary over the early stages of the 2009 Influenza A(H1N1)pdm09 epidemic in Birmingham and London, two key cities in the emergence of the UK epidemic. We evaluated the relative risk of infection in key ethnic minority groups and by national and city level deprivation rank.
We calculated higher incidence in more deprived areas and in people of South Asian ethnicity in both Birmingham and London, although the magnitude of these disparities reduced with time. The clearest disparities existed in school-aged children in Birmingham, where the most deprived fifth of the population was 2.8 times more likely to be infected than the most affluent fifth of the population.
Our analysis shows that although disparities in reported cases were present in the early phase of the Influenza A(H1N1)pdm09 outbreak in both Birmingham and London, they vary substantially depending on the period over which they are measured. Further, the development of disparities suggest that clustering of social groups play a key part as the outbreak appears to move from one ethnic and socio-demographic group to another. Finally, high incidence and large disparities between children indicate that they may hold an important role in driving inequalities.
在包括英国在内的许多高收入国家，少数民族群体在 2009 年大流行期间报告的甲型 H1N1pdm09 流感发病率和住院率及死亡率更高。这些研究中的许多都依赖于病例的地理和时间聚集，由于疫情传播的空间和时间因素，解释起来可能比较困难。此外，由于传播风险或疾病严重程度的差异，区分健康结果差异可能具有挑战性。
我们使用按族裔和贫困状况分类的匿名实验室确诊和疑似病例数据，评估在伯明翰和伦敦这两个英国疫情出现的关键城市，社会经济和族裔群体之间的风险差异在 2009 年甲型 H1N1pdm09 流感疫情的早期阶段如何变化。我们评估了在关键少数民族群体以及在国家和城市贫困程度排名中感染风险的相对风险。
我们发现，在伯明翰和伦敦，较贫困地区以及南亚裔人群的发病率更高，尽管这些差异的幅度随着时间的推移而减小。在伯明翰，最贫困的五分之一人口的感染可能性是最富裕的五分之一人口的 2.8 倍，这种差异在学龄儿童中最为明显。
我们的分析表明，尽管在伯明翰和伦敦的甲型 H1N1pdm09 疫情早期阶段报告的病例存在差异，但它们在很大程度上取决于测量的时间段。此外，差异的发展表明，社会群体的聚集在疫情从一个族裔和社会人口群体向另一个群体传播的过程中发挥了关键作用。最后，儿童的高发病率和巨大差异表明，他们可能在推动不平等方面发挥了重要作用。
