Variability in published rates of influenza-associated hospitalizations: A systematic review, 2007-2018

• Authors: Katherine M. Roguski, Centers for Disease Control and Prevention; Melissa A. Rolfes, Centers for Disease Control and Prevention; Jeremy S. Reich, Centers for Disease Control and Prevention; Zachary Owens, Emory University; Neha Patel, Centers for Disease Control and Prevention; Julia Fitzner, World Health Organization; Vanessa Cozza, World Health Organization; Kathryn E. Lafond, Centers for Disease Control and Prevention; Eduardo Azziz-Baumgartner, Centers for Disease Control and Prevention; A. Danielle Iuliano, Centers for Disease Control and Prevention
• Journal Title: JOURNAL OF GLOBAL HEALTH
• Volume: Volume 10, Number 2
• Publisher: INT SOC GLOBAL HEALTH | 2020-12-01, Pages 020430-020430
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7189/jogh.10.020430
• Subjects: Health Sciences, Public Health; Biology, Virology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; ACUTE RESPIRATORY ILLNESS; NATIONAL BURDEN; SYNCYTIAL VIRUS; INFECTIONS; PNEUMONIA; CHILDREN; DEATHS; KENYA

Abstract

Background Influenza burden estimates help provide evidence to support influenza prevention and control programs at local and international levels. Methods Through a systematic review, we aimed to identify all published articles estimating rates of influenza-associated hospitalizations, describe methods and data sources used, and identify regions of the world where estimates are still lacking. We evaluated study heterogeneity to determine if we could pool published rates to generate global estimates of influenza-associated hospitalization. Results We identified 98 published articles estimating influenza-associated hospitalization rates from 2007-2018. Most articles (65%) identified were from high-income countries, with 34 of those (53%) presenting estimates from the United States. While we identified fewer publications (18%) from low- and lower-middle-income countries, 50% of those were published from 2015-2018, suggesting an increase in publications from lower-income countries in recent years. Eighty percent (n = 78) used a multiplier approach. Regression modelling techniques were only used with data from upper-middle or high-income countries where hospital administrative data was available. We identified variability in the methods, case definitions, and data sources used, including 91 different age groups and 11 different categories of case definitions. Due to the high observed heterogeneity across articles (I2=99%), we were unable to pool published estimates. Conclusions The variety of methods, data sources, and case definitions adapted locally suggests that the current literature cannot be synthesized to generate global estimates of influenza-associated hospitalization burden.