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. 2014 Jan 15;179(2):156-67.
doi: 10.1093/aje/kwt235. Epub 2013 Nov 4.

Age- and sex-related risk factors for influenza-associated mortality in the United States between 1997-2007

Age- and sex-related risk factors for influenza-associated mortality in the United States between 1997-2007

Talia M Quandelacy et al. Am J Epidemiol. .

Abstract

Limited information on age- and sex-specific estimates of influenza-associated death with different underlying causes is currently available. We regressed weekly age- and sex-specific US mortality outcomes underlying several causes between 1997 and 2007 to incidence proxies for influenza A/H3N2, A/H1N1, and B that combine data on influenza-like illness consultations and respiratory specimen testing, adjusting for seasonal baselines and time trends. Adults older than 75 years of age had the highest average annual rate of influenza-associated mortality, with 141.15 deaths per 100,000 people (95% confidence interval (CI): 118.3, 163.9), whereas children under 18 had the lowest average mortality rate, with 0.41 deaths per 100,000 people (95% CI: 0.23, 0.60). In addition to respiratory and circulatory causes, mortality with underlying cancer, diabetes, renal disease, and Alzheimer disease had a contribution from influenza in adult age groups, whereas mortality with underlying septicemia had a contribution from influenza in children. For adults, within several age groups and for several underlying causes, the rate of influenza-associated mortality was somewhat higher in men than in women. Of note, in men 50-64 years of age, our estimate for the average annual rate of influenza-associated cancer mortality per 100,000 persons (1.90, 95% CI: 1.20, 2.62) is similar to the corresponding rate of influenza-associated respiratory deaths (1.81, 95% CI: 1.42, 2.21). Age, sex, and underlying health conditions should be considered when planning influenza vaccination and treatment strategies.

Keywords: age; influenza; mortality; sex; underlying cause.

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Figures

Figure 1.
Figure 1.
Weekly all-cause mortality rates per 100,000 people (solid lines) and model fits (circles) in different age groups, United States, 1997–2007. A) Persons 0–17 years of age; B) persons 18–49 years of age; C) persons 50–64 years of age; D) persons 65–74 years of age; E) persons 75 years of age or older.
Figure 2.
Figure 2.
Baseline rates of non–influenza-associated all-cause mortality in different age groups before (1997–mid 2001, solid line) and after (mid 2001–2007, dashed line) the introduction of the pneumococcal conjugate vaccine, United States, 1997–2007. A) Persons 0–17 years of age; B) persons 18–49 years of age; C) persons 50–64 years of age; D) persons 65–74 years of age; E) persons 75 years of age or older.

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