Limits...
Socio-economic disparities in the burden of seasonal influenza: the effect of social and material deprivation on rates of influenza infection.

Charland KM, Brownstein JS, Verma A, Brien S, Buckeridge DL - PLoS ONE (2011)

Bottom Line: Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97).Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital Informatics Program, Children's Hospital Boston, Boston, Massachusetts, United States of America. katia.charland@mcgill.ca

ABSTRACT

Background: There is little empirical evidence in support of a relationship between rates of influenza infection and level of material deprivation (i.e., lack of access to goods and services) and social deprivation (i.e. lack of social cohesion and support).

Method: Using validated population-level indices of material and social deprivation and medical billing claims for outpatient clinic and emergency department visits for influenza from 1996 to 2006, we assessed the relationship between neighbourhood rates of influenza and neighbourhood levels of deprivation using Bayesian ecological regression models. Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.

Results: Deprivation scores ranged from one to five with five representing the highest level of deprivation. We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97). There was little evidence of a meaningful linear relationship with material deprivation (RR 1.06, 95% CrI 0.93, 1.24). However, relative to neighbourhoods with deprivation scores in the bottom decile, those in the top decile (i.e., most materially deprived) had substantially higher rates (RR 2.02, 95% Confidence Interval 1.99, 2.05).

Conclusion: Though it is hypothesized that social and material deprivation increase risk of acute respiratory infection, we found decreasing healthcare utilization rates for influenza with increasing social deprivation. This finding may be explained by the fewer social contacts and, thus, fewer influenza exposure opportunities of the socially deprived. Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.

Show MeSH

Related in: MedlinePlus

Choropleth maps of neighborhood standardized morbidity ratios and deprivation scores.Standardized morbidity ratio for influenza (a), standardized morbidity ratio for pneumonia and influenza (b), Material deprivation (c), Social Deprivation (d).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3040776&req=5

pone-0017207-g001: Choropleth maps of neighborhood standardized morbidity ratios and deprivation scores.Standardized morbidity ratio for influenza (a), standardized morbidity ratio for pneumonia and influenza (b), Material deprivation (c), Social Deprivation (d).

Mentions: The correlation between the neighbourhood-level log standardized morbidity ratio (SMR) and the material and social deprivation score was 0.11 and −0.48, respectively. This finding is reflected in the choropleth maps (Figure 1), where areas with greater levels of social deprivation tended to have smaller SMRs. The results of the ecological regression indicated an average decrease in utilization rates by approximately 21% for every 1 unit increase in social deprivation score (Table 1). There did not appear to be a meaningful linear relationship with material deprivation (Table 1), nor was there evidence of an important interaction between social and material deprivation (regression coefficient −0.066, 95% CI −0.17 to 0.14). Results using the Pneumonia and Influenza definition were consistent with that of the Influenza definition (Table 1).


Socio-economic disparities in the burden of seasonal influenza: the effect of social and material deprivation on rates of influenza infection.

Charland KM, Brownstein JS, Verma A, Brien S, Buckeridge DL - PLoS ONE (2011)

Choropleth maps of neighborhood standardized morbidity ratios and deprivation scores.Standardized morbidity ratio for influenza (a), standardized morbidity ratio for pneumonia and influenza (b), Material deprivation (c), Social Deprivation (d).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3040776&req=5

pone-0017207-g001: Choropleth maps of neighborhood standardized morbidity ratios and deprivation scores.Standardized morbidity ratio for influenza (a), standardized morbidity ratio for pneumonia and influenza (b), Material deprivation (c), Social Deprivation (d).
Mentions: The correlation between the neighbourhood-level log standardized morbidity ratio (SMR) and the material and social deprivation score was 0.11 and −0.48, respectively. This finding is reflected in the choropleth maps (Figure 1), where areas with greater levels of social deprivation tended to have smaller SMRs. The results of the ecological regression indicated an average decrease in utilization rates by approximately 21% for every 1 unit increase in social deprivation score (Table 1). There did not appear to be a meaningful linear relationship with material deprivation (Table 1), nor was there evidence of an important interaction between social and material deprivation (regression coefficient −0.066, 95% CI −0.17 to 0.14). Results using the Pneumonia and Influenza definition were consistent with that of the Influenza definition (Table 1).

Bottom Line: Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97).Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital Informatics Program, Children's Hospital Boston, Boston, Massachusetts, United States of America. katia.charland@mcgill.ca

ABSTRACT

Background: There is little empirical evidence in support of a relationship between rates of influenza infection and level of material deprivation (i.e., lack of access to goods and services) and social deprivation (i.e. lack of social cohesion and support).

Method: Using validated population-level indices of material and social deprivation and medical billing claims for outpatient clinic and emergency department visits for influenza from 1996 to 2006, we assessed the relationship between neighbourhood rates of influenza and neighbourhood levels of deprivation using Bayesian ecological regression models. Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.

Results: Deprivation scores ranged from one to five with five representing the highest level of deprivation. We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97). There was little evidence of a meaningful linear relationship with material deprivation (RR 1.06, 95% CrI 0.93, 1.24). However, relative to neighbourhoods with deprivation scores in the bottom decile, those in the top decile (i.e., most materially deprived) had substantially higher rates (RR 2.02, 95% Confidence Interval 1.99, 2.05).

Conclusion: Though it is hypothesized that social and material deprivation increase risk of acute respiratory infection, we found decreasing healthcare utilization rates for influenza with increasing social deprivation. This finding may be explained by the fewer social contacts and, thus, fewer influenza exposure opportunities of the socially deprived. Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.

Show MeSH
Related in: MedlinePlus