Couture Alexia, Dahlgren F Scott, Izurieta Hector S, Forshee Richard A, Lu Yun, Reed Carrie
Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS 24/7, Atlanta, GA, 30329-4027, USA.
Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands.
BMC Public Health. 2025 Jan 23;25(1):291. doi: 10.1186/s12889-025-21555-4.
To improve understanding of influenza and rurality, we investigated differences in influenza testing and anti-viral treatment rates between micropolitan (muSAs) and metropolitan statistical areas (MSAs) using national medical claims data over multiple influenza seasons.
Using billing data from the Centers for Medicare and Medicaid Services for those aged 65 years and older, we estimated weekly rates of ordered rapid influenza diagnostic tests (RIDT) and antivirals (AV) among Medicare enrollees by core-based statistical areas (CBSAs) during 2010-2016. We used Negative Binomial generalized mixed models to estimate adjusted rate ratios (aRR) between MSAs and muSAs, adjusting for clustering by CBSA plus explanatory variables. We ran models for all weeks and only high influenza activity weeks.
For all weeks, the unadjusted rate of RIDTs was 1.97 per 10,000 people in MSAs compared with 2.69 in muSAs (Rate ratio (RR) = 0.73, 95% Confidence Interval (CI): 0.73-0.74) and of AVs was 1.85 in MSAs compared with 1.40 in muSAs (RR = 1.32, CI: 1.31-1.32). From the multivariate model, aRR for RIDTs was 0.82 (0.73-0.94) and for AVs was 1.12 (1.04-1.22) in MSAs versus muSAs. For high influenza activity weeks, aRR for RIDTs was 0.82 (0.73-0.92) and for AVs was 1.15 (1.06-1.24). All models found influenza testing rates higher in muSAs and treatment rates higher in MSAs.
Our study found lower testing and higher treatment in U.S. metropolitan versus micropolitan areas from 2010 to 2016 for those aged 65 years and older in our population. Identifying differences in influenza rates by rurality may improve public health response. Further research into the relationship of rurality and health disparities is needed.
为了更好地理解流感与农村地区的情况，我们利用多个流感季节的全国医疗理赔数据，调查了微型都市统计区（muSAs）和大都市统计区（MSAs）之间流感检测率和抗病毒治疗率的差异。
利用医疗保险和医疗补助服务中心针对65岁及以上人群的计费数据，我们估算了2010 - 2016年期间按核心基础统计区（CBSAs）划分的医疗保险参保人中每周的快速流感诊断检测（RIDT）和抗病毒药物（AV）订购率。我们使用负二项广义混合模型来估算MSAs和muSAs之间的调整率比（aRR），并对CBSA聚类以及解释变量进行调整。我们针对所有周以及仅流感活动高发周运行模型。
在所有周中，MSAs中每10000人未调整的RIDT率为1.97，而muSAs中为2.69（率比（RR） = 0.73，95%置信区间（CI）：0.73 - 0.74）；MSAs中AV的未调整率为1.85，而muSAs中为1.40（RR = 1.32，CI：1.31 - 1.32）。从多变量模型来看，MSAs与muSAs相比，RIDT的aRR为0.82（0.73 - 0.94），AV的aRR为1.12（1.04 - 1.22）。对于流感活动高发周，RIDT的aRR为0.82（0.73 - 0.92），AV的aRR为1.15（1.06 - 1.24）。所有模型均发现muSAs的流感检测率较高，而MSAs的治疗率较高。
我们的研究发现，2010年至2016年期间，美国大都市地区65岁及以上人群的流感检测率低于微型都市地区，而治疗率则高于微型都市地区。确定农村地区流感率的差异可能会改善公共卫生应对措施。需要进一步研究农村地区与健康差距之间的关系。
