The Social Determinants of Health and Pandemic H1N1 2009 Influenza Severity

Lowcock, Elizabeth C.; Rosella, Laura; Foisy, Julie; McGeer, Allison; Crowcroft, Natasha S.

doi:10.2105/ajph.2012.300814

Cited by 118 publications

(140 citation statements)

References 37 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Others have noted both an individual and ecological-level association between hospitalization for pH1N1 and indicators of low SES [35]. One possible explanation for the association with lower SES observed in our study is that surveillance case reporting was somehow biased toward reporting illness among those on public assistance.…”

Section: Discussionmentioning

confidence: 64%

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

2013

View full text Add to dashboard Cite

IntroductionPregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes.MethodsWe established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness.ResultsA total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes.ConclusionsCase-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment.

show abstract

Section: Discussionmentioning

confidence: 64%

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

2013

View full text Add to dashboard Cite

show abstract

“…Future work should consider holiday effects in populations that are poorly represented within medical claims data (e.g., uninsured individuals). These poorly captured populations may engage in systematically different holiday-associated behavioral changes, as lack of health insurance and financial barriers are known to affect health outcomes and care-seeking behavior in multiple contexts [51,52,34,53]. Nevertheless, U.S. medical claims will better represent the entire population in years after the implementation of the Affordable Care Act, which has substantially expanded insurance coverage among adults [54,55].…”

Section: Discussionmentioning

confidence: 99%

Contact, travel, and transmission: The impact of winter holidays on influenza dynamics in the United States

Ewing

Lee

Bansal

2016

Preprint

View full text Add to dashboard Cite

Background: The seasonality of influenza is thought to vary depending on changes in environmental factors, human contact, and travel patterns. During winter holidays, when children are out of school, typical patterns of potential disease-causing contact and travel change. The aim of this research is to understand the impact of winter school holidays on age-specific and spatial flu transmission, and the resulting size and spread of the epidemic. We hypothesize that reduced contacts among children during school holidays will lower their infection rates, infection rates among adults will subsequently decrease as fewer children are sick, and increased travel during the holidays will hasten the spread of flu across the country.Methods: Using aggregated medical claims data from physician offices and hospitals in the United States, we examined influenza dynamics before, during, and after the winter holidays from 2001 to 2009. We quantified the changes to transmission and characterized holiday-associated changes to epidemic trajectories among children and adults in a spatial context. Informed by this empirical evidence, we used a deterministic, age-specific spatial metapopulation model to compare models with and without holiday-associated behavioral changes to understand the effects of holidays on flu season trajectories and spatial spread. Results:In analyzing eight seasons of medical claims data, we observed a mean 15% drop in the effective reproductive number immediately after Christmas. Rates of influenza-like illness among children experienced a sharp dip and recovery during and after the holidays, while adults experienced more gradual dips and recoveries during these periods. The model results demonstrated that both child and adult flu incidence dipped during the holiday period, but trends among adults lagged those in children. The peaks of the child and adult flu epidemics were delayed when the holiday was introduced, but the attack rate did not change significantly for either age group. In the medical claims data and the model-generated data with the holiday, the spatial synchrony of epidemic trajectories before and after the holiday remained similar. In the model-generated data without the holiday, however, epidemic trajectories became spatially asynchronous.Conclusions: Our work suggests that winter holidays delay the epidemic peaks and increase the spatial synchrony of natural trajectories for seasonal influenza in the United States every year. These findings have implications for the design of influenza intervention strategies, such as the proper timing and duration of school closures, and the spatial and demographic reallocation of vaccines.

show abstract

“…22 In Canada, a lower education, aboriginal ethnicity, and living in a highly deprived neighborhood were all associated with higher hospitalization rates due to 2009 H1N1. 23 The causal mechanisms leading to these disparities may differ by location, but our previous studies suggest a framework for designing research to uncover these mechanisms. For example, underlying conditions did not fully explain observed inequalities in hospitalization rates in Canada; 23 similarly, underlying chronic conditions and access to health care did not fully explain inequalities in New York City, 19 suggesting that factors further upstream, including differential rates of exposure to virus because of differences in social mixing or differential susceptibility to disease because of differences in vaccination behavior, may need to be examined.…”

Section: Social Determinants Of Health and International Health Inequmentioning

confidence: 96%

Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security

Quinn¹,

Kumar²

2014

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, an

294

228

View full text Add to dashboard Cite

In today's global society, infectious disease outbreaks can spread quickly across the world, fueled by the rapidity with which we travel across borders and continents. Historical accounts of influenza pandemics and contemporary reports on infectious diseases clearly demonstrate that poverty, inequality, and social determinants of health create conditions for the transmission of infectious diseases, and existing health disparities or inequalities can further contribute to unequal burdens of morbidity and mortality. Yet, to date, studies of influenza pandemic plans across multiple countries find little to no recognition of health inequalities or attempts to engage disadvantaged populations to explicitly address the differential impact of a pandemic on them. To meet the goals and objectives of the Global Health Security Agenda, we argue that international partners, from WHO to individual countries, must grapple with the social determinants of health and existing health inequalities and extend their vision to include these factors so that disease that may start among socially disadvantaged subpopulations does not go unnoticed and spread across borders. These efforts will require rethinking surveillance systems to include sociodemographic data; training local teams of researchers and community health workers who are able to not only analyze data to recognize risk factors for disease, but also use simulation methods to assess the impact of alternative policies on reducing disease; integrating social science disciplines to understand local context; and proactively anticipating shortfalls in availability of adequate healthcare resources, including vaccines. Without explicit attention to existing health inequalities and underlying social determinants of health, the Global Health Security Agenda is unlikely to succeed in its goals and objectives.

show abstract

The Social Determinants of Health and Pandemic H1N1 2009 Influenza Severity

Cited by 118 publications

References 37 publications

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

Contact, travel, and transmission: The impact of winter holidays on influenza dynamics in the United States

Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security

Contact Info

Product

Resources

About