Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918
Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918
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DOI：
10.1073/pnas.1612838113
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发表时间：
2016-11-29
影响因子：
11.1
通讯作者：
Cummings, Derek A. T.
中科院分区：
文献类型：
--
作者：
Grantz, Kyra H.;Rane, Madhura S.;Cummings, Derek A. T.
社会因素已被证明会在不同的地理区域造成不同的流感负担。我们使用7,971例流感和肺炎死亡的历史数据集，探讨了1918年芝加哥流感大流行期间潜在的总体水平社会决定因素与死亡率之间的关系。人口普查区一级的社会因素，包括文盲率、住房拥有率、人口和失业率，被评估为芝加哥流行病死亡率的预测因子。Poisson模型与广义估计方程（GEE）拟合用于估计社会因素与流感和肺炎死亡率风险之间的关联。泊松模型显示，在人口密度、住房拥有率、失业率和年龄调整后，文盲率每增加10%，流感和肺炎死亡率平均增加32.2%。我们还发现了一个显着的关联性和人口密度，文盲率和失业率，但不是房屋所有权。最后，对报告的流感和肺炎死亡的点位置的分析揭示了精细尺度的时空聚集。这项研究表明，在1918年芝加哥流感大流行期间，居住在文盲率较高的人口普查区增加了流感和肺炎死亡率的风险。我们的观察，在结构性决定因素的差异，社区一级的健康导致流感发病率的差异，在这一大流行病表明，差异及其决定因素应继续在未来的大流行病的研究和控制的目标。
Social factors have been shown to create differential burden of influenza across different geographic areas. We explored the relationship between potential aggregate-level social determinants and mortality during the 1918 influenza pandemic in Chicago using a historical dataset of 7,971 influenza and pneumonia deaths. Census tract-level social factors, including rates of illiteracy, homeownership, population, and unemployment, were assessed as predictors of pandemic mortality in Chicago. Poisson models fit with generalized estimating equations (GEEs) were used to estimate the association between social factors and the risk of influenza and pneumonia mortality. The Poisson model showed that influenza and pneumoniamortality increased, on average, by 32.2% for every 10% increase in illiteracy rate adjusted for population density, homeownership, unemployment, and age. We also found a significant association between transmissibility and population density, illiteracy, and unemployment but not homeownership. Lastly, analysis of the point locations of reported influenza and pneumonia deaths revealed fine-scale spatiotemporal clustering. This study shows that living in census tracts with higher illiteracy rates increased the risk of influenza and pneumonia mortality during the 1918 influenza pandemic in Chicago. Our observation that disparities in structural determinants of neigh-borhood-level health lead to disparities in influenza incidence in this pandemic suggests that disparities and their determinants should remain targets of research and control in future pandemics.