1740. Social Determinants of Influenza Hospitalization in the United States
Session: Oral Abstract Session: Influenza - Impact on Healthcare and Healthcare Providers
Saturday, October 29, 2016: 8:45 AM
Room: 388-390
Background: Influenza hospitalizations result in significant morbidity and mortality each year. Recent analyses have reported twice the incidence of influenza hospitalization in high compared to low poverty areas; however, little is known about the independent association between neighborhood-level socioeconomic (SES) measures and influenza hospitalization rates.

Methods: We analyzed data from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a national population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations, conducted in 14 states, and representing approximately 9% of the U.S. population. We analyzed 34,386 hospitalizations that occurred during 2009-2010 through 2013-2014 influenza seasons. Cases were geocoded, matched to census tracts (CT) and joined with the corresponding CT SES data from the American Community Survey. We computed age-adjusted influenza hospitalization incidence rates by SES variables and surveillance site. We fit a multilevel logistic regression model to evaluate associations between influenza hospitalization rates and SES measures including percent living below poverty, population density, female head of household, and household crowding and individual age, race, gender and ethnicity.

Results: All individual level demographics were significantly associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.3 (95% CI 8.8-9.7) for adults 65 years and older versus children 5-17 years. African Americans had an AOR of 1.7 (95% CI 1.6-1.72) compared to Whites. All SES measures were significantly associated with influenza hospitalization except for population density. Patients living in a CT with more than 20% versus <5% of persons living below poverty level had an AOR of 1.3 (95% CI 1.1-1.4). Those living in CT with over 40% versus <20% of persons with a female head of household had an AOR of 1.3 (95% CI 1.2-1.4). Persons living in a CT with on average more than 5 versus <5 persons per room had an AOR of 1.2 (95% CI 1.1-1.3).

Conclusion: Neighborhood-level SES measures are independently associated with influenza hospitalizations rates, suggesting that targeted vaccination efforts may be useful in high-poverty CT.

Rameela Chandrasekhar, Ph.D.1, Chantel Sloan, Ph.D.2, Edward Mitchel Jr., MS3, Danielle Ndi, MPH3, Lisa Miller, MD, MSPH4, Ann Thomas, MD, MPH5, Nancy Bennett, MD, MS6, Pam Kirley, MPH7, Melanie Spencer, MPH8, Evan J. Anderson, MD9, Ruth Lynfield, MD, FIDSA10, Kimberly Yousey-Hindes, MPH, CPH11, Marisa Bargsten, MPH12, Shelley M. Zansky, PhD13, Krista Lung, MPH14, Monica Schroeder, MPH15, Charisse Nitura Cummings, MPH16, Shikha Garg, MD, MPH16, William Schaffner, MD, FIDSA, FSHEA17 and Mary Louise Lindegren, MD, MPH17, (1)Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, (2)Department of Health Science, Brigham Young University, Provo, UT, (3)Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, (4)Colorado Department of Public Health and Environment, Denver, CO, (5)Acute and Communicable Disease Prevention Section, Oregon Health Authority, Portland, OR, (6)University of Rochester Medical Center, Rochester, NY, (7)California Emerging Infections Program, Oakland, CA, (8)Salt Lake County Health Department, Salt Lake City, UT, (9)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (10)Minnesota Department of Health, St. Paul, MN, (11)Emerging Infections Program, Yale, New Haven, CT, (12)New Mexico Department of Health, Santa Fe, NM, (13)NY State Dept of Health, Albany, NY, (14)Bureau of Infectious Diseases, Ohio Department of Health, Columbus, OH, (15)Council of State and Territorial Epidemiologists, Atlanta, GA, (16)Centers for Disease Control and Prevention, Atlanta, GA, (17)Vanderbilt University School of Medicine, Nashville, TN


R. Chandrasekhar, None

C. Sloan, None

E. Mitchel Jr., None

D. Ndi, None

L. Miller, None

A. Thomas, None

N. Bennett, None

P. Kirley, None

M. Spencer, None

E. J. Anderson, None

R. Lynfield, None

K. Yousey-Hindes, None

M. Bargsten, None

S. M. Zansky, None

K. Lung, None

M. Schroeder, None

C. Nitura Cummings, None

S. Garg, None

W. Schaffner, None

M. L. Lindegren, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.