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
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 (3–5). 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.
- Fiore AE, Fry A, Shay D, Gubareva L, Bresee J, Uyeki T. Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2011;60:1–24.
- Subramanian SV, Chen J, Rehkopf D, Waterman P, Krieger N. Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: a multilevel analysis of Massachusetts births, 1989–1991. Am J Epidemiol. 2006;164:823–34.
- Lindley MC, Wortley PM, Winston CA, Bardenheier BH. The role of attitudes in understanding disparities in adult influenza vaccination. Am J Prev Med. 2006;31:281–5.
- Fiscella K, Dressler R, Meldrum S, Holt K. Impact of influenza vaccination disparities on elderly mortality in the United States. Prev Med.2007;45:83–7.
- Lees KA, Wortley PM, Coughlin SS. Comparison of racial/ethnic disparities in adult immunization and cancer screening. Am J Prev Med.2005;29:404–11.
- Yousey-Hindes KM, Hadler JL. Neighborhood socioeconomic status and influenza hospitalizations among children: New Haven County, Connecticut, 2003–2010. Am J Public Health. 2011;101.
- Tam K, Yousey‐Hindes K, Hadler JL. Influenza‐related hospitalization of adults associated with low census tract socioeconomic status and female sex in New Haven County, Connecticut, 2007‐2011. Influenza Other Respir Viruses. 2014;8:274–81.
- Addressing emerging infectious disease threats: a prevention strategy for the United States. Executive summary. MMWR Recomm Rep. 1994;43:1–18.
- Preventing emerging infectious diseases: a strategy for the 21st century. Overview of the updated CDC plan. MMWR Recomm Rep. 1998;47:1–14.
- Esri. ArcMap 10.0. Redlands (CA): Environmental Systems Research Institute; 2010.
- Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian S. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health. 2005;95:312–23.
- Newling BE. The spatial variation of urban population densities. Geogr Rev. 1969;59:242–52.
- Wagstaff A, Paci P, Van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33:545–57.
- Ohmit SE, Thompson MG, Petrie JG, Thaker SN, Jackson ML, Belongia EA, Influenza vaccine effectiveness in the 2011–2012 season: protection against each circulating virus and the effect of prior vaccination on estimates. Clin Infect Dis. 2014;58:319–27.
- Fiscella K. Tackling disparities in influenza vaccination in primary care: it takes a team. J Gen Intern Med. 2014;29:1579–81.
- Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000;51:1143–61.
- Hebert PL, Frick KD, Kane RL, McBean AM. The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries. Health Serv Res. 2005;40:517–37.
- Lowcock EC, Rosella LC, Foisy J, McGeer A, Crowcroft N. The social determinants of health and pandemic H1N1 2009 influenza severity. Am J Public Health. 2012;102:e51–8.
- Corburn J, Osleeb J, Porter M. Urban asthma and the neighbourhood environment in New York City. Health Place. 2006;12:167–79.
- Claudio L, Tulton L, Doucette J, Landrigan PJ. Socioeconomic factors and asthma hospitalization rates in New York City. J Asthma. 1999;36:343–50.
- Charland KM, Buckeridge DL, Hoen AG, Berry JG, Elixhauser A, Melton F, Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States. Influenza Other Respir Viruses. 2013;7:718–28.
- Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992;82:703–10.
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