1957. Neighborhood-Level Poverty, Poverty-Associated Factors, and Severe Outcomes among Adults Hospitalized with Influenza—United States, 2012–2015
Session: Poster Abstract Session: Clinical: Respiratory Track
Saturday, October 7, 2017
Room: Poster Hall CD
  • Schicker_ID Week_Poster_Final.pdf (224.6 kB)
  • Background:Recent studies demonstrated higher influenza-associated hospitalization rates among individuals living in high-poverty neighborhoods. We explored the further impact of neighborhood-level poverty and individual, poverty-associated factors, on severe outcomes among hospitalized patients with influenza.

    Methods: We linked 2012–2015 data on hospitalized adults from the influenza hospitalization surveillance network (FluSurv-NET), by census tract, to the American Community Survey’s federal poverty estimates. High-poverty neighborhoods were defined as census tracts with ≥20% of households in poverty and low-poverty neighborhoods, <5%. We explored univariate associations between neighborhood-level poverty and influenza vaccination, tobacco use, alcohol abuse, and extreme obesity. Using logistic regression and clustering by census tract, we examined the independent association of these factors with intensive care unit (ICU) admission and death, controlling for age, race, sex, comorbid conditions, antiviral treatment, season, and time from symptom onset to hospitalization.

    Results: Among 26,106 patients, 4,194 (16%) required ICU admission and 669 (3%) died. Those who currently used tobacco, abused alcohol, were extremely obese, or were unvaccinated were more likely to live in high-poverty (38%, 40%, 37%, 33%) compared with low-poverty neighborhoods (12%, 13%, 13%, 16%; P<.01), respectively. Living in a high-poverty neighborhood was not independently associated with ICU admission (OR: 0.97, CI: 0.87–1.10) or death (OR: 0.82, CI: 0.63–1.08). Being unvaccinated (OR: 1.24, CI: 1.15–1.35), tobacco use (OR: 1.31, CI: 1.19–1.45), and alcohol abuse (OR: 1.68, CI: 1.41–2.00) increased odds of ICU admission; extreme obesity increased odds of death (OR: 1.35, CI: 1.02–1.78).

    Conclusion: Poverty-associated factors, but not neighborhood-level poverty, were independently associated with severe outcomes among patients hospitalized with influenza. Increased vaccination and reductions in tobacco use, alcohol abuse, and extreme obesity could reduce severe influenza-associated outcomes.

    Rebekah Stewart Schicker, MSN, MPH, APRN1, Kimberly Yousey-Hindes, MPH, CPH2, Melissa a. Rolfes, PhD, MPH3, Charisse Nitura Cummings, MPH4, Evan J. Anderson, MD5, Marisa Bargsten, MPH6, Nancy Bennett, MD, MS7, Seth Eckel, MPH8, Krista Lung, MPH9, Melissa McMahon, MPH10, Lisa Miller, MD, MSPH11, Maya Monroe, MPH12, Ilene Risk, MPA13, William Schaffner, MD, FIDSA, FSHEA14, Ann Thomas, MD, MPH15, James Watt, MD, MPH16, Shelley M. Zansky, PhD17, Carrie Reed, DSc, MPH4, Alicia M. Fry, MD, MPH4 and Shikha Garg, MD, MPH4, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Emerging Infections Program, Yale, New Haven, CT, (3)Yale School of Public Health, New Haven, CT, (4)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (5)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (6)New Mexico Department of Health, Santa Fe, NM, (7)University of Rochester Medical Center, Rochester, NY, (8)Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, MI, (9)Bureau of Infectious Diseases, Ohio Department of Health, Columbus, OH, (10)Minnesota Department of Health, St. Paul, MN, (11)Preventive Medicine Residency Program, University of Colorado School of Public Health, Aurora, CO, (12)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (13)Salt Lake County Health Department, Salt Lake City, UT, (14)Vanderbilt University School of Medicine, Nashville, TN, (15)Oregon Public Health Division, Portland, OR, (16)Center for Infectious Diseases, California Department of Public Health, Sacramento, CA, (17)New York State Department of Health, Albany, NY


    R. S. Schicker, None

    K. Yousey-Hindes, None

    M. A. Rolfes, None

    C. Nitura Cummings, None

    E. J. Anderson, AbbVie: Consultant , Consulting fee
    NovaVax: Research Contractor , Research support
    Regeneron: Research Contractor , Research grant
    MedImmune: Research Contractor , Research grant and Research support

    M. Bargsten, None

    N. Bennett, None

    S. Eckel, None

    K. Lung, None

    M. McMahon, None

    L. Miller, None

    M. Monroe, None

    I. Risk, None

    W. Schaffner, Pfizer: Scientific Advisor , Consulting fee
    Merck: Scientific Advisor , Consulting fee
    Novavax: Consultant , Consulting fee
    Dynavax: Consultant , Consulting fee
    Sanofi-pasteur: Consultant , Consulting fee
    GSK: Consultant , Consulting fee
    Seqirus: Consultant , Consulting fee

    A. Thomas, None

    J. Watt, None

    S. M. Zansky, None

    C. Reed, None

    A. M. Fry, None

    S. Garg, None

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