Dataset Information

Influenza-associated mortality in Yancheng, China, 2011-15.

ABSTRACT: INTRODUCTION:The Yangtze river delta in eastern China, centered on Shanghai, is one of the most populated regions of the world with more than 100 million residents. We examined the impact of influenza on excess mortality in Yancheng, a prefecture-level city with 8.2 million population located 250 km north of Shanghai, during 2011-2015. METHODS:We obtained individual data on deaths by date, age, sex, and cause in Yancheng from the Chinese Centers for Disease Control and Prevention, and used these to derive weekly rates of mortality from respiratory causes, respiratory and cardiovascular causes combined, and all causes. We used data on influenza-like illnesses and laboratory detections of influenza to construct a proxy measure of the weekly incidence of influenza virus infections in the community. We used regression models to estimate the association of influenza activity with mortality and excess mortality by age, cause, and influenza type/subtype. RESULTS:We estimated that an annual average of 4.59 (95% confidence interval: 3.94, 7.41) excess respiratory deaths per 100 000 persons were associated with influenza, which was 4.6% of all respiratory deaths in the years studied. Almost all influenza-associated excess deaths occurred in persons ?65 years. Influenza A(H3N2) had the greatest impact on mortality and was associated with around 50% of the influenza-associated respiratory deaths in the 5 years studied. CONCLUSIONS:Influenza has a substantial impact on respiratory mortality in Yancheng, mainly in older adults. Influenza vaccination has the potential to reduce disease burden, and cost-effectiveness analysis could be used to compare policy options.

SUBMITTER: Zhang H

PROVIDER: S-EPMC5818359 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Influenza-associated mortality in Yancheng, China, 2011-15.

Zhang Hongjun H Xiong Qian Q Wu Peng P Chen Yuyun Y Leung Nancy H L NHL Cowling Benjamin J BJ

Influenza and other respiratory viruses 20171128 1

<h4>Introduction</h4>The Yangtze river delta in eastern China, centered on Shanghai, is one of the most populated regions of the world with more than 100 million residents. We examined the impact of influenza on excess mortality in Yancheng, a prefecture-level city with 8.2 million population located 250 km north of Shanghai, during 2011-2015.<h4>Methods</h4>We obtained individual data on deaths by date, age, sex, and cause in Yancheng from the Chinese Centers for Disease Control and Prevention, ...[more]

PMID: 29193690

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Project description:BackgroundThe estimation of influenza-associated excess mortality in countries can help to improve estimates of the global mortality burden attributable to influenza virus infections. We did a study to estimate the influenza-associated excess respiratory mortality in mainland China for the 2010-11 through 2014-15 seasons.MethodsWe obtained provincial weekly influenza surveillance data and population mortality data for 161 disease surveillance points in 31 provinces in mainland China from the Chinese Center for Disease Control and Prevention for the years 2005-15. Disease surveillance points with an annual average mortality rate of less than 0·4% between 2005 and 2015 or an annual mortality rate of less than 0·3% in any given years were excluded. We extracted data for respiratory deaths based on codes J00-J99 under the tenth edition of the International Classification of Diseases. Data on respiratory mortality and population were stratified by age group (age <60 years and ≥60 years) and aggregated by province. The overall annual population data of each province and national annual respiratory mortality data were compiled from the China Statistical Yearbook. Influenza surveillance data on weekly proportion of samples testing positive for influenza virus by type or subtype for 31 provinces were extracted from the National Sentinel Hospital-based Influenza Surveillance Network. We estimated influenza-associated excess respiratory mortality rates between the 2010-11 and 2014-15 seasons for 22 provinces with valid data in the country using linear regression models. Extrapolation of excess respiratory mortality rates was done using random-effect meta-regression models for nine provinces without valid data for a direct estimation of the rates.FindingsWe fitted the linear regression model with the data from 22 of 31 provinces in mainland China, representing 83·0% of the total population. We estimated that an annual mean of 88 100 (95% CI 84 200-92 000) influenza-associated excess respiratory deaths occurred in China in the 5 years studied, corresponding to 8·2% (95% CI 7·9-8·6) of respiratory deaths. The mean excess respiratory mortality rates per 100 000 person-seasons for influenza A(H1N1)pdm09, A(H3N2), and B viruses were 1·6 (95% CI 1·5-1·7), 2·6 (2·4-2·8), and 2·3 (2·1-2·5), respectively. Estimated excess respiratory mortality rates per 100 000 person-seasons were 1·5 (95% CI 1·1-1·9) for individuals younger than 60 years and 38·5 (36·8-40·2) for individuals aged 60 years or older. Approximately 71 000 (95% CI 67 800-74 100) influenza-associated excess respiratory deaths occurred in individuals aged 60 years or older, corresponding to 80% of such deaths.InterpretationInfluenza was associated with substantial excess respiratory mortality in China between 2010-11 and 2014-15 seasons, especially in older adults aged at least 60 years. Continuous and high-quality surveillance data across China are needed to improve the estimation of the disease burden attributable to influenza and the best public health interventions are needed to curb this burden.FundingNational Science Fund for Distinguished Young Scholars, National Science and Technology Major Project of China, National Institute of Health Research, the Harvard Center for Communicable Disease Dynamics from the National Institute of General Medical Sciences, and the China-US Collaborative Program on Emerging and Re-emerging Infectious Disease.

Project description:ObjectiveThis study comprehensively estimated the excess cardiovascular disease (CVD) mortality attributable to influenza in an older (age ≥65 years) population.DesignEcological study.SettingAggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data in Beijing, China.Main outcome measureExcess overall CVD, and separately for ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature.ResultsCVD (risk ratio (RR) 1.02, 95% CI 1.01, 1.02), IHD (RR 1.01, 95% CI 1.01, 1.02), ischaemic stroke (RR=1.03, 95% CI 1.02, 1.04), but not haemorrhagic stroke (RR=1.00, 95% CI 0.99, 1.01) mortality, were significantly associated with every 10% increase in influenza activity. An increase in circulating A(H1N1)09pdm, A(H3N2) and B type virus were all significantly associated with CVD and ischaemic stroke mortality, but only A(H3N2) and B type virus with IHD mortality. The strongest increase in disease mortality was in the same week as the increase in influenza activity. Annual excess CVD mortality rate attributable to influenza ranged from 54 to 96 per 100 000 population. The 3%-6% CVD mortality attributable to influenza activity was related to an annual excess of 916-1640 CVD deaths in Beijing, China.ConclusionsInfluenza activity has moderate to strong associations with CVD, IHD and ischaemic stroke mortality in older adults in China. Promoting influenza vaccination could have major health benefit in this population.BackgroundInfluenza may trigger serious CVD events. An estimation of excess CVD mortality attributable to influenza has particular relevance in China where vaccination is low and CVD burden is high.MethodsThis study analysed data at the population level (age ≥65 years) using linked aggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data during 2011 to 2018. Quasi-Poisson regression models were used to estimate the excess overall CVD, and separately for IHD, ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature. Analyses were also undertaken for influenza subtypes (A(H1N1)09pdm, A(H3N2) and B viruses), and mortality risk with time lags of 1-5 weeks following influenza activity in the current week.

Dataset Information

Influenza-associated mortality in Yancheng, China, 2011-15.

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Influenza-associated mortality in Yancheng, China, 2011-15.

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