The social determinants of health and pandemic H1N1 2009 influenza severity.
The social determinants of health and pandemic H1N1 2009 influenza severity.
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DOI：
10.2105/ajph.2012.300814
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发表时间：
2012-08-01
影响因子：
12.7
通讯作者：
Crowcroft, Natasha
中科院分区：
文献类型：
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作者：
Lowcock, Elizabeth C;Rosella, Laura C;Crowcroft, Natasha
目的：我们探讨健康的社会决定因素对2009年H1N1流感大流行严重程度的影响，以及临床危险因素在介导这种关联中的作用。方法：在加拿大安大略省的一项病例对照研究中，我们使用多元逻辑回归和广义估计方程来检验个体和生态层面的健康和2009年H1N1大流行性疾病住院治疗的社会决定因素之间的关联。结果：在第一流行阶段（2009年4月23日至7月20日），住院与高中以下学历和生活在高度物质匮乏或完全贫困的社区有关。我们还观察到了第二阶段（2009年8月1日至11月6日）与教育的关系。2009年H1N1大流行疾病的临床危险因素介导了所观察到的39%的关联。结论：2009年H1N1大流行重症的主要临床危险因素只能解释部分健康社会决定因素与住院治疗之间的关联，这表明健康社会决定因素影响2009年H1N1大流行结局的手段超出了临床认可的危险因素。
OBJECTIVES: We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations.METHODS: We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada.RESULTS: During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association.CONCLUSIONS: The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.