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Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC


Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
Emerging Infections Program

Emerging Infections Program

Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA

Chantel Sloan, Rameela Chandrasekhar, Edward Mitchel, William Schaffner, and Mary Lou LindegrenComments to Author 
Author affiliations: Brigham Young University, Provo, Utah, USA (C. Sloan)Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C. Sloan, R. Chandrasekhar, E. Mitchel, W. Schaffner, M.L. Lindegren)


We examined population-based surveillance data from the Tennessee Emerging Infections Program to determine whether neighborhood socioeconomic status was associated with influenza hospitalization rates. Hospitalization data collected during October 2007–April 2014 were geocoded (N = 1,743) and linked to neighborhood socioeconomic data. We calculated age-standardized annual incidence rates, relative index of inequality, and concentration curves for socioeconomic variables. Influenza hospitalizations increased with increased percentages of persons who lived in poverty, had female-headed households, lived in crowded households, and lived in population-dense areas. Influenza hospitalizations decreased with increased percentages of persons who were college educated, were employed, and had health insurance. Higher incidence of influenza hospitalization was also associated with lower neighborhood socioeconomic status when data were stratified by race.
Influenza causes annual outbreaks that result in >200,000 hospitalizations and 3,300–49,000 deaths annually in the United States (1). Children <2 years of age, persons >65 years of age, pregnant women, and those with underlying health conditions are at greater risk for developing serious complications (e.g., pneumonia) from influenza and are at greater risk for hospitalization and death. Despite continuing vaccine and treatment interventions, the public health effects of annual influenza epidemics remain substantial.
Although patient-level risk factors for severity of influenza have long been identified, attention is being directed towards reporting neighborhoods and contextual and environmental characteristics that increase risk for adverse health outcomes and that are independent of patient-level attributes (2). Geographic-based measures include physical, social, and economic characteristics of neighborhoods, such as poverty level, education, residential segregation, psychosocial stress, unemployment, inadequate transportation, social networks, distance to medical facilities, access to prevention and treatment services, insurance status, environmental exposures, and housing and density characteristics. Disparities in health outcomes likely result from a combination of factors that influence an individual’s exposures, risk behaviors, susceptibility, treatment options, and social contextual factors (35). However, rarely are these measures collected through population-based surveillance systems. Previous work investigating influenza disparities showed a strong positive correlation between influenza hospitalization rates and geographic areas of high poverty and household crowding (6,7).
We analyzed population-based influenza hospitalization surveillance data from the Tennessee Emerging Infections Program (EIP) (8,9) to identify potential disparities in influenza hospitalization rates in Middle Tennessee according to neighborhood-level measures of socioeconomic status (SES). Understanding disparities in influenza hospitalization rates is a priority for the EIP as necessary to reduce illness and death from annual influenza epidemics.
Dr. Sloan is an assistant professor in the Department of Health Science at Brigham Young University. Her primary research interest is the spatial epidemiology of both chronic and infectious respiratory diseases.


We thank Karen Leib and Katie Dyer for their contributions to Influenza Hospitalization Surveillance Network.
This analysis was supported by Cooperative Agreement 5U50CK000198-03 from the Centers for Disease Control and Prevention, Atlanta, GA, USA.


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Technical Appendix

Suggested citation for this article: Sloan C, Chandrasekhar R, Mitchel E, Schaffner W, Lindegren ML. Socioeconomic disparities and influenza hospitalizations, Tennessee, USA. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.141861
DOI: 10.3201/eid2109.141861

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