Social Vulnerability, Intervention Utilization, and Outcomes in US Adults Hospitalized With Influenza

Details

• Alternative Title:
  JAMA Netw Open
• Personal Author:
  Adams, Katherine ; Yousey-Hindes, Kimberly ; Bozio, Catherine H. ; Jain, Seema ; Kirley, Pam Daily ; Armistead, Isaac ; Alden, Nisha B. ; Openo, Kyle P. ; Witt, Lucy S. ; Monroe, Maya L. ; Kim, Sue ; Falkowski, Anna ; Lynfield, Ruth ; McMahon, Melissa ; Hoffman, Marisa R. ; Shaw, Yomei P. ; Spina, Nancy L. ; Rowe, Adam ; Felsen, Christina B. ; Licherdell, Erin ; Lung, Krista ; Shiltz, Eli ; Thomas, Ann ; Talbot, H. Keipp ; Schaffner, William ; Crossland, Melanie T. ; Olsen, Kristen P. ; Chang, Larry W. ; Cummings, Charisse N. ; Tenforde, Mark W. ; Garg, Shikha ; Hadler, James L. ; O’Halloran, Alissa
• Description:
  IMPORTANCE
  
  Seasonal influenza is associated with substantial disease burden. The relationship between census tract–based social vulnerability and clinical outcomes among patients with influenza remains unknown.
  
  OBJECTIVE
  
  To characterize associations between social vulnerability and outcomes among patients hospitalized with influenza and to evaluate seasonal influenza vaccine and influenza antiviral utilization patterns across levels of social vulnerability.
  
  DESIGN, SETTING, AND PARTICIPANTS
  
  This retrospective repeated cross-sectional study was conducted among adults with laboratory-confirmed influenza-associated hospitalizations from the 2014 to 2015 through the 2018 to 2019 influenza seasons. Data were from a population-based surveillance network of counties within 13 states. Data analysis was conducted in December 2023.
  
  EXPOSURE
  
  Census tract–based social vulnerability.
  
  MAIN OUTCOMES AND MEASURES
  
  Associations between census tract–based social vulnerability and influenza outcomes (intensive care unit admission, invasive mechanical ventilation and/or extracorporeal membrane oxygenation support, and 30-day mortality) were estimated using modified Poisson regression as adjusted prevalence ratios. Seasonal influenza vaccine and influenza antiviral utilization were also characterized across levels of social vulnerability.
  
  RESULTS
  
  Among 57 964 sampled cases, the median (IQR) age was 71 (58–82) years; 55.5% (95% CI, 51.5%–56.0%) were female; 5.2% (5.0%–5.4%) were Asian or Pacific Islander, 18.3% (95% CI, 18.0%–18.6%) were Black or African American, and 64.6% (95% CI, 64.2%–65.0%) were White; and 6.6% (95% CI, 6.4%–68%) were Hispanic or Latino and 74.7% (95% CI, 74.3%–75.0%) were non-Hispanic or Latino. High social vulnerability was associated with higher prevalence of invasive mechanical ventilation and/or extracorporeal membrane oxygenation support (931 of 13 563 unweighted cases; adjusted prevalence ratio [aPR], 1.25 [95% CI, 1.13–1.39]), primarily due to socioeconomic status (790 of 11 255; aPR, 1.31 [95% CI, 1.17–1.47]) and household composition and disability (773 of 11 256; aPR, 1.20 [95% CI, 1.09–1.32]). Vaccination status, presence of underlying medical conditions, and respiratory symptoms partially mediated all significant associations. As social vulnerability increased, the proportion of patients receiving seasonal influenza vaccination declined (−19.4% relative change across quartiles; P < .001) as did the proportion vaccinated by October 31 (−6.8%; P < .001). No differences based on social vulnerability were found in in-hospital antiviral receipt, but early in-hospital antiviral initiation (−1.0%; P = .01) and prehospital antiviral receipt (−17.3%; P < .001) declined as social vulnerability increased.
  
  CONCLUSIONS AND RELEVANCE
  
  In this cross-sectional study, social vulnerability was associated with a modestly increased prevalence of invasive mechanical ventilation and/or extracorporeal membrane oxygenation support among patients hospitalized with influenza. Contributing factors may have included worsened baseline respiratory health and reduced receipt of influenza prevention and prehospital or early in-hospital treatment interventions among persons residing in low socioeconomic areas.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Antiviral Agents Cross-Sectional Studies Extracorporeal Membrane Oxygenation Female Hospitalization Humans Influenza, Human Influenza Vaccines Male Middle Aged Retrospective Studies Social Vulnerability United States Young Adult

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• Source:
  JAMA Netw Open. 7(11):e2448003
• Pubmed ID:
  39602116
• Pubmed Central ID:
  PMC11702903
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; NU38OT000297/CC/CDC HHSUnited States/ ; U38 OT000143/OT/OSTLTS CDC HHSUnited States/
• Volume:
  7
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a77b0174390d964e4e89367d1ce48ee2ca895b781d437b7665e084c680b277d3fa78b13dfb926ab3208a439e55012a5d002378cf283277d11af204cc9649f15e
• Download URL:
  https://stacks.cdc.gov/view/cdc/175427/cdc_175427_DS1.pdf
• File Type:
  [PDF - 672.47 KB ]