Socio-economic disparities in the burden of seasonal influenza: the effect of social and material deprivation on rates of influenza infection.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: Electronic Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Cost of Illness* ; Health Status Disparities* ; Psychosocial Deprivation* ; Social Class*; Influenza, Human/*economics ; Influenza, Human/*epidemiology; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Healthcare Disparities/statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Influenza, Human/etiology ; Male ; Middle Aged ; Quebec/epidemiology ; Risk Factors ; Seasons ; Socioeconomic Factors ; Young Adult

Background: There is little empirical evidence in support of a relationship between rates of influenza infection and level of material deprivation (i.e., lack of access to goods and services) and social deprivation (i.e. lack of social cohesion and support).
Method: Using validated population-level indices of material and social deprivation and medical billing claims for outpatient clinic and emergency department visits for influenza from 1996 to 2006, we assessed the relationship between neighbourhood rates of influenza and neighbourhood levels of deprivation using Bayesian ecological regression models. Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.
Results: Deprivation scores ranged from one to five with five representing the highest level of deprivation. We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97). There was little evidence of a meaningful linear relationship with material deprivation (RR 1.06, 95% CrI 0.93, 1.24). However, relative to neighbourhoods with deprivation scores in the bottom decile, those in the top decile (i.e., most materially deprived) had substantially higher rates (RR 2.02, 95% Confidence Interval 1.99, 2.05).
Conclusion: Though it is hypothesized that social and material deprivation increase risk of acute respiratory infection, we found decreasing healthcare utilization rates for influenza with increasing social deprivation. This finding may be explained by the fewer social contacts and, thus, fewer influenza exposure opportunities of the socially deprived. Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.

Psychosom Med. 2007 Apr;69(3):225-34. (PMID: 17401058)
Respir Med. 2003 Nov;97(11):1219-24. (PMID: 14635977)
J R Stat Soc Ser A Stat Soc. 2008 Jan 1;171(1):179-202. (PMID: 20052294)
PLoS One. 2010 Sep 15;5(9):e12948. (PMID: 20856792)
Emerg Infect Dis. 2007 Feb;13(2):207-16. (PMID: 17479881)
Br J Gen Pract. 2008 Jun;58(551):400-2. (PMID: 18505611)
Biostatistics. 2007 Apr;8(2):158-83. (PMID: 16809429)
N Engl J Med. 2001 Jul 12;345(2):134-6. (PMID: 11450663)
Soc Sci Med. 2008 Dec;67(12):1995-2006. (PMID: 18950921)
N Engl J Med. 2001 Mar 22;344(12):889-96. (PMID: 11259722)
Soc Sci Med. 2008 Feb;66(3):691-703. (PMID: 18022302)
Psychosom Med. 1995 May-Jun;57(3):245-54. (PMID: 7652125)
BMC Public Health. 2004 Jun 03;4:19. (PMID: 15176983)
Ann Behav Med. 2010 Feb;39(1):79-90. (PMID: 20151235)
Ann N Y Acad Sci. 2008;1136:28-31. (PMID: 18579873)
Soc Sci Med. 2007 Apr;64(8):1636-50. (PMID: 17250939)
Health Serv Res. 2008 Dec;43(6):2223-38. (PMID: 18665858)
Soc Sci Med. 2007 Apr;64(8):1651-64. (PMID: 17287059)
Arch Intern Med. 2010 Mar 22;170(6):570-2. (PMID: 20308645)
PLoS Med. 2007 Aug;4(8):e247. (PMID: 17683196)
Am J Epidemiol. 2005 Oct 1;162(7):686-93. (PMID: 16107568)
Ann Behav Med. 2004 Apr;27(2):91-9. (PMID: 15026293)
Chronic Dis Can. 2000;21(3):104-13. (PMID: 11082346)
Stat Med. 2006 Jun 30;25(12):2136-59. (PMID: 16217847)
Epidemiol Rev. 1990;12:149-78. (PMID: 2286216)
Respir Med. 2006 Jul;100(7):1282-5. (PMID: 16300939)

R21 LM009263 United States LM NLM NIH HHS; R21 AI073591-02 United States AI NIAID NIH HHS; R21AI073591-01 United States AI NIAID NIH HHS; R21 AI073591 United States AI NIAID NIH HHS; CAT 86857 Canada CAPMC CIHR; PAN-83152 Canada CAPMC CIHR; R21LM009263-01 United States LM NLM NIH HHS

Date Created: 20110302 Date Completed: 20110901 Latest Revision: 20211020

20250114

PMC3040776

10.1371/journal.pone.0017207

21359150