Open AccessSocial determinants of influenza hospitalization in the United States
Author(s) -
Chandrasekhar Rameela,
Sloan Chantel,
Mitchel Edward,
Ndi Danielle,
Alden Nisha,
Thomas Ann,
Bennett Nancy M.,
Kirley Pam D.,
Hill Mary,
Anderson Evan J.,
Lynfield Ruth,
YouseyHindes Kimberly,
Bargsten Marisa,
Zansky Shelley M.,
Lung Krista,
Schroeder Monica,
Monroe Maya,
Eckel Seth,
Markus Tiffanie M.,
Cummings Charisse N.,
Garg Shikha,
Schaffner William,
Lindegren Mary Lou
Publication year - 2017
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.12483
Subject(s) - demography , socioeconomic status , medicine , census tract , odds ratio , poverty , odds , logistic regression , population , census , respiratory tract infections , gerontology , environmental health , sociology , respiratory system , economics , economic growth
Background 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. Objective 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. Methods 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. Results 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). Conclusion Census tract‐based determinants account for 11% of the variability in influenza hospitalization.