Regional variation in mortality impact of the 2009 A(H1N1) influenza pandemic in China

Influenza and Other Respiratory Viruses

Hongjie Yu¹  Luzhao Feng⁵  Cecile G. Viboud⁶  David K. Shay²  Yong Jiang⁷  Hong Zhou³  Maigeng Zhou⁴  Zhen Xu⁵  Nan Hu⁷  Weizhong Yang⁵ 

[1] Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA;National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA;Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China;Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China;Fogarty International Center, National Institutes of Health, Bethesda, MD, USA;National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

关键词: A(H1N1) pandemic;    China;    influenza;    mortality;    negative binomial model;    regional variation;   

DOI  :  10.1111/irv.12121

来源: Wiley

【 摘 要 】

Abstract

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 China 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(H1N1) 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(H1N1)pdm circulation.

Conclusions

The A(H1N1) 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.

【 授权许可】

Unknown   
© 2013 John Wiley & Sons Ltd