Open AccessRegional variation in mortality impact of the 2009 A ( H 1 N 1) influenza pandemic in C hina
Author(s) -
Yu Hongjie,
Feng Luzhao,
Viboud Cecile G.,
Shay David K.,
Jiang Yong,
Zhou Hong,
Zhou Maigeng,
Xu Zhen,
Hu Nan,
Yang Weizhong,
Nie Shaofa
Publication year - 2013
Publication title -
influenza and other respiratory viruses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.743
H-Index - 57
eISSN - 1750-2659
pISSN - 1750-2640
DOI - 10.1111/irv.12121
Subject(s) - pandemic , medicine , demography , excess mortality , population , epidemiology , environmental health , china , mortality rate , influenza a virus , covid-19 , geography , virology , disease , infectious disease (medical specialty) , virus , archaeology , sociology
Background Laboratory‐confirmed deaths grossly underestimate influenza mortality burden, so that reliable burden estimates are derived from indirect statistical studies, which are scarce in low‐ and middle‐income settings. Objectives Here, we used statistical excess mortality models to estimate the burden of seasonal and pandemic influenza in China. Methods We modeled data from a nationally representative population‐based death registration system, combined with influenza virological surveillance data, to estimate influenza‐associated excess mortality for the 2004–2005 through 2009–2010 seasons, by age and region. Results The A(H1N1) pandemic was associated with 11·4–12·1 excess respiratory and circulatory ( R & C ) deaths per 100 000 population in rural sites of northern and southern C hina during 2009–2010; these rates were 2·2–2·8 times higher than those of urban sites ( P < 0·01). Influenza B accounted for a larger proportion of deaths than pandemic A ( H 1 N 1) in 2009–2010 in some regions. Nationally, we attribute 126 200 (95% CI , 61 000–248 400) excess R&C deaths (rate of 9·4/100 000) and 2 323 000 (1 166 000–4 533 000) years of life lost ( YLL ) to the first year of A ( H 1 N 1)pdm circulation. Conclusions The A ( H 1 N 1) pandemic posed a mortality and YLL burden comparable to that of interpandemic influenza in China. Our high burden estimates in rural areas highlight the need to enhance epidemiological surveillance and healthcare services, in underdeveloped and remote areas.