Dataset Information

Estimates of US influenza-associated deaths made using four different methods.

ABSTRACT:

Background

A wide range of methods have been used for estimating influenza-associated deaths in temperate countries. Direct comparisons of estimates produced by using different models with US mortality data have not been published.

Objective

Compare estimates of US influenza-associated deaths made by using four models and summarize strengths and weaknesses of each model.

Methods

US mortality data from the 1972-1973 through 2002-2003 respiratory seasons and World Health Organization influenza surveillance data were used to estimate influenza-associated respiratory and circulatory deaths. Four models were used: (i) rate-difference (using peri-season or summer-season baselines), (ii) Serfling least squares cyclical regression, (iii) Serfling-Poisson regression, (iv) and autoregressive integrated moving average models.

Results

Annual estimates of influenza-associated deaths made using each model were similar and positively correlated, except for estimates from the summer-season rate-difference model, which were consistently higher. From the 1976/1977 through the 2002/2003 seasons the, the Poisson regression models estimated that an annual average of 25,470 [95% confidence interval (CI) 19,781-31,159] influenza-associated respiratory and circulatory deaths [9.9 deaths per 100,000 (95% CI 7.9-11.9)], while peri-season rate-difference models using a 15% threshold estimated an annual average of 22,454 (95% CI 16,189-28,719) deaths [8.6 deaths per 100,000 (95% CI 6.4-10.9)].

Conclusions

Estimates of influenza-associated mortality were of similar magnitude. Poisson regression models permit the estimation of deaths associated with influenza A and B, but require robust viral surveillance data. By contrast, simple peri-season rate-difference models may prove useful for estimating mortality in countries with sparse viral surveillance data or complex influenza seasonality.

SUBMITTER: Thompson WW

PROVIDER: S-EPMC4986622 | biostudies-literature | 2009 Jan

REPOSITORIES: biostudies-literature

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Publications

Estimates of US influenza-associated deaths made using four different methods.

Thompson William W WW Weintraub Eric E Dhankhar Praveen P Cheng Po-Yung PY Brammer Lynnette L Meltzer Martin I MI Bresee Joseph S JS Shay David K DK

Influenza and other respiratory viruses 20090101 1

<h4>Background</h4>A wide range of methods have been used for estimating influenza-associated deaths in temperate countries. Direct comparisons of estimates produced by using different models with US mortality data have not been published.<h4>Objective</h4>Compare estimates of US influenza-associated deaths made by using four models and summarize strengths and weaknesses of each model.<h4>Methods</h4>US mortality data from the 1972-1973 through 2002-2003 respiratory seasons and World Health Orga ...[more]

PMID: 19453440

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Project description:BACKGROUND: Estimates of the effectiveness of influenza vaccines in older adults may be biased because of difficulties identifying and adjusting for confounders of the vaccine-outcome association. We estimated vaccine effectiveness for prevention of serious influenza complications among older persons by using methods to account for underlying differences in risk for these complications. METHODS: We conducted a retrospective cohort study among Ontario residents aged ? 65 years from September 1993 through September 2008. We linked weekly vaccination, hospitalization, and death records for 1.4 million community-dwelling persons aged ? 65 years. Vaccine effectiveness was estimated by comparing ratios of outcome rates during weeks of high versus low influenza activity (defined by viral surveillance data) among vaccinated and unvaccinated subjects by using log-linear regression models that accounted for temperature and time trends with natural spline functions. Effectiveness was estimated for three influenza-associated outcomes: all-cause deaths, deaths occurring within 30 days of pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations. RESULTS: During weeks when 5% of respiratory specimens tested positive for influenza A, vaccine effectiveness among persons aged ? 65 years was 22% (95% confidence interval [CI], -6%-42%) for all influenza-associated deaths, 25% (95% CI, 13%-37%) for deaths occurring within 30 days after an influenza-associated pneumonia/influenza hospitalization, and 19% (95% CI, 4%-31%) for influenza-associated pneumonia/influenza hospitalizations. Because small proportions of deaths, deaths after pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations were associated with influenza virus circulation, we estimated that vaccination prevented 1.6%, 4.8%, and 4.1% of these outcomes, respectively. CONCLUSIONS: By using confounding-reducing techniques with 15 years of provincial-level data including vaccination and health outcomes, we estimated that influenza vaccination prevented ~4% of influenza-associated hospitalizations and deaths occurring after hospitalizations among older adults in Ontario.

Dataset Information

Estimates of US influenza-associated deaths made using four different methods.

Background

Objective

Methods

Results

Conclusions

Publications

Estimates of US influenza-associated deaths made using four different methods.

Similar Datasets

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