Socio-Economic Disparities in the Burden of Seasonal Influenza The Effect of Social and Material Deprivation on Rates of Influenza Infection 英文参考文献.docVIP

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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 英文参考文献.doc

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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 英文参考文献

Socio-EconomicDisparitiesintheBurdenofSeasonal Influenza:TheEffectofSocialandMaterialDeprivation onRatesofInfluenzaInfection KatiaM.Charland1,2,3,4*,JohnS.Brownstein1,2,4,AmanVerma3,4,StephanieBrien3,4,DavidL. Buckeridge3,4,5 1Children’s Hospital Informatics Program, Children’s Hospital Boston, Boston, Massachusetts, United States of America, 2Department of Pediatrics, Harvard Medical School,Boston,Massachusetts,UnitedStatesofAmerica, 3McGillClinicalandHealthInformatics, McGillUniversity,Montreal,Canada,4DepartmentofEpidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada, 5Office of Surveillance and Epidemiology, Montreal Public Health Department, Montreal, Canada Abstract Background:Thereislittleempiricalevidenceinsupportofarelationshipbetweenratesofinfluenzainfectionandlevelof 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 outpatientclinicandemergencydepartmentvisitsforinfluenzafrom1996to2006,weassessedtherelationshipbetween neighbourhoodratesofinfluenzaandneighbourhoodlevelsofdeprivationusingBayesianecologicalregressionmodels. Then,bypoolingdatafromneighbourhoodsinthetopdecile(i.e.,mostdeprived)andthebottomdecile,wecompared ratesinthemostdeprivedpopulationstotheleastdeprivedpopulationsusingage-andsex-standardizedrateratios. Results:Deprivationscoresrangedfromonetofivewithfiverepresentingthehighestlevelofdeprivation.Wefounda21% reductioninratesforevery1unitincreaseinsocialdeprivationscore(rateratio[RR]0.79,95%CredibleInterval[CrI]0.66, 0.97).Therewaslittleevidenceofameaningfullinearrelationshipwithmaterialdeprivation(RR1.06,95%CrI0.93,1.24). However, relative to neighbourhoods with deprivation scores in the bottom decile, those in the top decile (i.e., most materiallydeprived)hadsubstantiallyhigherrates(RR2.02,95%ConfidenceInte