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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.

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Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.
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pone-0017207-g002: Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.

Mentions: Plots of the neighbourhood log SMR versus deprivation score are shown in Figure 2. The rate of utilization for influenza among populations living in the most materially deprived neighbourhoods (top decile) were 102% higher than those living in the least materially deprived neighbourhoods (Table 2). When we excluded neighbourhoods that had both high or both low material and social deprivation scores, we found an even greater disparity in rates (rate ratio [RR] 4.65, 95% Confidence Interval [CI] 4.55 to 4.76). In comparing the most to the least socially deprived neighbourhoods we found that the most socially deprived populations had approximately 79% lower utilization rates for influenza and 81% lower rates for pneumonia and influenza (Table 2). When neighbourhoods with deprivation scores in the top and bottom 5% and 15% were analysed, we found similar patterns of elevated risk in the materially deprived populations and decreased risk in the socially deprived populations were observed (Table 2).


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)

Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0017207-g002: Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.
Mentions: Plots of the neighbourhood log SMR versus deprivation score are shown in Figure 2. The rate of utilization for influenza among populations living in the most materially deprived neighbourhoods (top decile) were 102% higher than those living in the least materially deprived neighbourhoods (Table 2). When we excluded neighbourhoods that had both high or both low material and social deprivation scores, we found an even greater disparity in rates (rate ratio [RR] 4.65, 95% Confidence Interval [CI] 4.55 to 4.76). In comparing the most to the least socially deprived neighbourhoods we found that the most socially deprived populations had approximately 79% lower utilization rates for influenza and 81% lower rates for pneumonia and influenza (Table 2). When neighbourhoods with deprivation scores in the top and bottom 5% and 15% were analysed, we found similar patterns of elevated risk in the materially deprived populations and decreased risk in the socially deprived populations were observed (Table 2).

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