Social factors related to the clinical severity of influenza cases in Spain during the A (H1N1) 2009 virus pandemic

BMC Public Health

Ángela Domínguez⁸  Sonia Tamames³  Núria Soldevila⁸  José María Quintana⁸  Tomás Pumarola⁷  Vicente Martín⁸  Fernando Gónzález-Candelas⁸  Pere Godoy⁸  Alicia Ferri⁸  Miguel Delgado-Rodríguez^1,10  Ady Castro¹  Rafael Cantón⁴  Jesús Castilla⁹  Maretva Baricot⁸  Jenaro Astray⁶  Zaida Herrador⁵  Olatz Garín⁸  Jordi Alonso⁸  José María Mayoral² 

[1]CIBER Enfermedades Respiratorias _Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain

[2]Sº de Epidemiología. Consejería de Salud. Andalucía, Avda. de la Innovación s/n, 41080, Sevilla, Spain

[3]Dirección General de Salud Pública e Investigación, Desarrollo e Innovación, Junta de Castilla y León, Valladolid, Spain

[4]Hospital Universitario Ramón y Cajal, Madrid, Spain

[5]Programa de Epidemiología Aplicada de Campo, ISCIII, Madrid, Spain

[6]Área de Epidemiología, Comunidad de Madrid, Madrid, Spain

[7]Red Española de Investigación en Patología Infecciosa, Madrid, Spain

[8]CIBER Epidemiología y Salud Pública, Barcelona, Spain

[9]Instituto de Salud Pública de Navarra, Pamplona, Spain

[10]Universidad de Jaén, Jaén, Spain

关键词: Social factors;    Hospitalization;    Pandemic;    Influenza A (H1N1) 2009;   

Others  :  1162561
DOI  :  10.1186/1471-2458-13-118

 received in 2012-11-14, accepted in 2013-01-29,  发布年份 2013

【 摘 要 】

Background

During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection.

Methods

We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models.

Results

Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87)

Conclusions

In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections.

【 授权许可】

   
2013 Mayoral et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Semenza JC, Giesecke J: Intervening to reduce inequalities in infections in Europe. Am J Public Health 2008, 98:787-92.
• [2]Wilkinson RG, Pickett KE: Income inequality and population health: a review and explanation of the evidence. Soc Sci Med 2006, 62:1768-84.
• [3]Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ: Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet 1997, 349:1655-59.
• [4]Marmot MG, Kogevinas M, Elston MA: Social/economic status and disease. Ann Rev of Public Health 1987, 8:111-35.
• [5]Whitehead M, Burstrom B, Diderichsen F: Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden. Soc Sci Med 2000, 50:255-70.
• [6]Regidor E, Martinez D, Astasio P, Ortega P, Calle ME, Dominguez V: Trends of socioeconomic inequalities and socioeconomic inequalities in selfperceived health in Spain. Gac Sanit 2006, 20:178-82.
• [7]Marmot M, Wilkinson RG: Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. BMJ 2001, 322:1233-6h.
• [8]Pradas Velasco R, Villar FA, Puy Martínez-Zárate M: Use of European Quality of Life-5 Dimensions (EQ-5D) questionnaire to value the health related quality of life variation because of influenza. Gac Sanit 2009, 23:104-8.
• [9]Ministerio de Sanidad y Política Social de España (MSPS): Hacia la equidad en salud: monitorización de los determinantes sociales de la salud y reducción de las desigualdades en salud. 2010. Disponible en: http://www.msps.es/profesionales/saludPublica/prevPromocion/promocion/desigualdadSalud/PresidenciaUE_2010/conferenciaExpertos/docs/haciaLaEquidadEnSalud.pdf webcite
• [10]Regidor E, De Mateo S, Calle ME, Domínguez V: Educational level and mortality from infectious diseases. J Epidemiol Community Health 2002, 56:682-3.
• [11]Semenza JC, Suk JE, Tsolova S: Social determinants of infectious diseases: a public health priority. Euro Surveill 2010, 15:2-4.
• [12]Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NP: World War I may have allowed the emergence of “Spanish” influenza. Lancet Infect Dis 2002, 2:111-4.
• [13]Marmot MG, et al.: Fair society, healthy lives: the marmot review. London; 2010. Available online: http://www.marmotreview.org/ webcite
• [14]Agüero F, Adell MN, Pérez Giménez A, et al.: Adoption of preventive measures during and after the 2009 influenza A (H1N1) virus pandemic peak in Spain. Prev Med 2011., 12Epub ahead of print
• [15]Yamada T: Poverty, wealth, and access to pandemic influenza vaccines. N Engl J Med 2009, 361:1129-31.
• [16]Ferreira Antunes JL, Waldman EA, Borrell C, Paiva TM: Effectiveness of influenza vaccination and its impact on health inequalities. Int J Epidemiol 2007, 36:1319-1326.
• [17]Santa-Olalla P, Cortes-García M, Vicente-Herrero M, Surveillance Group for New Influenza A(H1N1) Virus Investigation and Control Team in Spain, et al.: Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April - December 2009. Euro Surveill 2010, 15(38):pii=19667. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19667 webcite
• [18]Centers for Disease Control and Prevention (CDC): Patients hospitalized with 2009 pandemic influenza A (H1N1) -- New York City, May 2009. MMWR 2010, 58:1436-40.
• [19]Nickel KB, Marsden-Haug NL, Kathryn H, et al.: Age as an independent risk factor for Intensive Care Unit admission or death due to 2009 pandemic influenza A(H1N1) virus infection. Public Health Reports 2011, 126:349-53.
• [20]Mayoral Cortés JM, Puell Gómez L, Pérez Morilla E, et al.: Behaviour of the pandemic H1N1 influenza virus in Andalusia, Spain, at the onset of the 2009–10 season. Euro Surveill 2009, 14(49):pii=19433. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19433 webcite
• [21]Simón Méndez L, de Mateo OS, Larrauri Cámara A, et al.: Transmisibilidad y gravedad de la pandemia de gripe A(H1N1)2009 en España. Gac Sanit 2011, 25:296-302.
• [22]Echevarría-Zuna E, Mejía-Aranguré JM, Mar-Obeso AJ, et al.: Infection and death from influenza A(H1N1) virus in Mexico: a retrospective analysis. Lancet 2009, 374:2072-9.
• [23]Santa-Olalla P, Cortes García M, Limia Sánchez A, et al.: Casos de infección por gripe pandémica (H1N1) 2009 hospitalizados en cuidados intensivos en España: factores asociados a riesgo de muerte, abril 2009-enero 2010. Rev Esp Salud Publica 2010, 84:547-567.
• [24]Domínguez A, Alonso J, Astray J, Grupo de Trabajo del Proyecto CIBERESP de Casos y Controles sobre la Gripe Pandémica, et al.: Risk factors of influenza (H1N1) 2009 hospitalization and effectiveness of pharmaceutical and nonpharmaceutical interventions in its prevention: a case–control study. Rev Esp Salud Publica 2011, 85:3-15.
• [25]Garin O, Galante M, García-Altés A, et al.: Use of services and costs in patients with Influenza (H1N1) 2009 in Spain: background and research protocol. Rev Esp Salud Pública 2011, 85:19-31.
• [26]Brouwers L, Cakici B, Camitz M, Tegnell A, Boman M: Economic consequences to society of pandemic H1N1 influenza 2009 - preliminary results for Sweden. Euro Surveill 2009, 14(37):pii=19333. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19333 webcite
• [27]Bennett KJ, et al.: Rural–urban differences in the location of influenza vaccine administration. Vaccine 2011, 29:5970-5977.
• [28]Yousey-Hindes KM, James L: Hadler neighborhood socioeconomic status and influenza hospitalizations among children: New haven county, Connecticut, 2003–2010. Am J Public Health 2011, 101:1785-1789.
• [29]Commission of the European Communities: Together for health: a strategic approach for the EU 2008–2013. Brussels; 2007. http://ec.europa.eu/health/ph_overview/Documents/strategy_wp_en.pdf webcite
• [30]Schlesselman JJ: Case–control studies. Design, conduct, analysis. New York: Oxford University Press; 1982:144-70.
• [31]Louie JK, Acosta M, Winter K, et al.: Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA 2009, 302:1896-902.
• [32]Van Kerkhove MD, Vandemaele KA, Shinde V, on behalf of the WHO Working Group for Risk Factors for Severe H1N1 Infection, et al.: Risk factors for severe outcomes following 2009 Influenza A (H1N1) Infection: a global pooled analysis. PLoS Med 8(7):e1001053.
• [33]Dahlgren , Whitehead : “Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe”. Arbetsrapport. Stockholm, Sweden: Institute for Futures Studies; 2007:14.
• [34]Kramers PGN: The ECHI project. Health indicators for the European community. Eur J Public Health 2003, 13(suppl 3):101-106.
• [35]Williams CJ, Schweiger B, Diner G, et al.: Seasonal influenza risk in hospital healthcare workers is more strongly associated with household than occupational exposures: results from a prospective cohort study in Berlin, Germany, 2006/07. BMC Infect Dis 2010, 10:8. http://www.biomedcentral.com/1471-2334/10/8 webcite BioMed Central Full Text
• [36]Troko J, Myles P, Gibson J, et al.: Is public transport a risk factor for acute respiratory infection? BMC Infectious Diseases 2011, 11:16. http://www.biomedcentral.com/1471-2334/11/16 webcite BioMed Central Full Text
• [37]Maldonado JL, Cortés Alcalá L: Características del parque de viviendas de la Comunidad de Madrid según el Censo de 2001. Consejería de Economía e Innovación Tecnológica. Instituto de Estadística de la Comunidad de Madrid: Instituto de Estadística de la Comunidad de Madrid; 1435-2005. DL:M
• [38]Esteban-Vasallo MD, Domínguez-Berjón MF, Aerny-Perreten N, et al.: Pandemic influenza A (H1N1) 2009 in Madrid, Spain: incidence and characteristics in immigrant and native population. Eur J Public Healthckr171 first published online December 8, 2011
• [39]Truman BI, Tinker T, Vaughan E, et al.: Pandemic influenza preparedness and response among immigrants and refugees. Am J Public Health 2009, 99(Suppl 2):S278-286.
• [40]Centers for Disease Control and Prevention. (CDC): Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives - 12 states. MMWR 2009, 58:1341-4.
• [41]Benach J, Amable M: Las clases sociales y la pobreza. Gac Sanit 2004, 18(Supl 1):16-23.
• [42]Márquez Calderón S, Villegas Portero R, Aguado Romeo MJ: La utilización de los servicios sanitarios en Andalucía: ¿perpetuación o corrección de las desigualdades? Primer Informe sobre Desigualdades y Salud en Andalucía. Asociación para la Defensa de la Sanidad Pública de Andalucía (ADSP-A), Edita; 2008:145-165.
• [43]O’Malley AS, Forrest CB: Immunization disparities in older Americans: determinants and future research needs. Am J Prev Med 2006, 31:150-8.