Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019

• Type of Material: Article
• Authors: Alissa C O'Halloran, Centers for Disease Control and Prevention, Atlanta; Rachel Holstein, Centers for Disease Control and Prevention, Atlanta; Charisse Cummings, Centers for Disease Control and Prevention, Atlanta; Pam Daily Kirley, California Emerging Infections Program; Nisha B Alden, Colorado Department of Public Health and Environment; Kimberly Yousey-Hindes, Yale School of Public Health; Evan Anderson, Emory University; Patricia Ryan, Maryland Department of Health; Sue Kim, Michigan Department of Health and Human Services; Ruth Lynfield, Minnesota Department of Health; Chelsea McMullen, New Mexico Department of Health; Nancy M Bennett, University of Rochester; Nancy Spina, New York State Department of Health; Laurie M Billing, Ohio Department of Health; Melissa Sutton, Oregon Health Authority; William Schaffner, Vanderbilt University; Keipp H Talbot, Vanderbilt University; Andrea Price, Salt Lake County Health Department; Alicia M Fry, Centers for Disease Control and Prevention, Atlanta; Carrie Reed, Emory University; Shikha Garg, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2021-08-24
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2021 O’Halloran AC et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2021.21880
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 4
• Issue: 8
• Start Page: e2121880
• End Page: e2121880
• Grant/Funding Information: his work was supported by the Centers of Disease Control and Prevention (CDC) through an Emerging Infections Program cooperative agreement (grant No. CK17-1701) and through a Council of State and Territorial Epidemiologists cooperative agreement (grant No. NU38OT000297-02-00).
• Keywords: ADULT-POPULATIONS; SURVEILLANCE; General & Internal Medicine; VACCINATION COVERAGE; MORTALITY; DISPARITIES; Medicine, General & Internal; VIRUS; Science & Technology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Importance: Racial and ethnic minority groups, such as Black, Hispanic, American Indian or Alaska Native, and Asian or Pacific Islander persons, often experience higher rates of severe influenza disease. Objective: To describe rates of influenza-associated hospitalization, intensive care unit (ICU) admission, and in-hospital death by race and ethnicity over 10 influenza seasons. Design, Setting, and Participants: This cross-sectional study used data from the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET), which conducts population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected counties, representing approximately 9% of the US population. Influenza hospitalizations from the 2009 to 2010 season to the 2018 to 2019 season were analyzed. Data were analyzed from October 2020 to July 2021. Main Outcomes and Measures: The main outcomes were age-adjusted and age-stratified rates of influenza-associated hospitalization, ICU admission, and in-hospital death by race and ethnicity overall and by influenza season. Results: Among 113352 persons with an influenza-associated hospitalization (34436 persons [32.0%] aged ≥75 years; 61009 [53.8%] women), 70225 persons (62.3%) were non-Hispanic White (White), 24850 persons (21.6%) were non-Hispanic Black (Black), 11903 persons (10.3%) were Hispanic, 5517 persons (5.1%) were non-Hispanic Asian or Pacific Islander, and 857 persons (0.7%) were non-Hispanic American Indian or Alaska Native. Among persons aged younger than 75 years and compared with White persons of the same ages, Black persons were more likely to be hospitalized (eg, age 50-64 years: rate ratio [RR], 2.50 95% CI, 2.43-2.57) and to be admitted to an ICU (eg, age 50-64 years: RR, 2.09; 95% CI, 1.96-2.23). Among persons aged younger than 50 years and compared with White persons of the same ages, American Indian or Alaska Native persons were more likely to be hospitalized (eg, age 18-49 years: RR, 1.72; 95% CI, 1.51-1.96) and to be admitted to an ICU (eg, age 18-49 years: RR, 1.84; 95% CI, 1.40-2.42). Among children aged 4 years or younger and compared with White children, hospitalization rates were higher in Black children (RR, 2.21; 95% CI, 2.10-2.33), Hispanic children (RR, 1.87; 95% CI, 1.77-1.97), American Indian or Alaska Native children (RR, 3.00; 95% CI, 2.55-3.53), and Asian or Pacific Islander children (RR, 1.26; 95% CI, 1.16-1.38), as were rates of ICU admission (Black children: RR, 2.74; 95% CI, 2.43-3.09; Hispanic children: RR, 1.96; 95% CI, 1.73-2.23; American Indian and Alaska Native children: RR, 3.51; 95% CI, 2.45-5.05). In this age group and compared with White children, in-hospital death rates were higher among Hispanic children (RR, 2.98; 95% CI, 1.23-7.19), Black children (RR, 3.39; 95% CI, 1.40-8.18), and Asian or Pacific Islander children (RR, 4.35; 95% CI, 1.55-12.22). Few differences were observed in rates of severe influenza-associated outcomes by race and ethnicity among adults aged 75 years or older. For example, in this age group, compared with White adults, hospitalization rates were slightly higher only among Black adults (RR, 1.05; 95% CI 1.02-1.09). Overall, Black persons had the highest age-adjusted hospitalization rate (68.8 [95% CI, 68.0-69.7] hospitalizations per 100000 population) and ICU admission rate (11.6 [95% CI, 11.2-11.9] admissions per 100000 population). Conclusions and Relevance: This cross-sectional study found racial and ethnic disparities in rates of severe influenza-associated disease. These data identified subgroups for whom improvements in influenza prevention efforts could be targeted..