11 research outputs found
Recommended from our members
Clinic accessibility and clinic-level predictors of the geographic variation in 2009 pandemic influenza vaccine coverage in Montreal, Canada
Background: Nineteen mass vaccination clinics were established in Montreal, Canada, as part of the 2009 influenza A/H1N1p vaccination campaign. Although approximately 50% of the population was vaccinated, there was a considerable variation in clinic performance and community vaccine coverage. Objective: To identify community- and clinic-level predictors of vaccine uptake, while accounting for the accessibility of clinics from the community of residence. Methods: All records of influenza A/H1N1p vaccinations administered in Montreal were obtained from a vaccine registry. Multivariable regression models, specifically Bayesian gravity models, were used to assess the relationship between vaccination rates and clinic accessibility, clinic-level factors, and community-level factors. Results: Relative risks compare the vaccination rates at the variable's upper quartile to the lower quartile. All else being equal, clinics in areas with high violent crime rates, high residential density, and high levels of material deprivation tended to perform poorly (adjusted relative risk [ARR]: 0·917, 95% CI [credible interval]: 0·915, 0·918; ARR: 0·663, 95% CI: 0·660, 0·666, ARR: 0·649, 95% CI: 0·645, 0·654, respectively). Even after controlling for accessibility and clinic-level predictors, communities with a greater proportion of new immigrants and families living below the poverty level tended to have lower rates (ARR: 0·936, 95% CI: 0·913, 0·959; ARR: 0·918, 95% CI: 0·893, 0·946, respectively), while communities with a higher proportion speaking English or French tended to have higher rates (ARR: 1·034, 95% CI: 1·012, 1·059). Conclusion: In planning future mass vaccination campaigns, the gravity model could be used to compare expected vaccine uptake for different clinic location strategies
Socio-Economic Disparities in the Burden of Seasonal Influenza: The Effect of Social and Material Deprivation on Rates of Influenza Infection
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).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.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).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
Recommended from our members
Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States
Please cite this paper as: Charland et al.(2012) Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12019. Background Findings from studies examining the association between obesity and acute respiratory infection are inconsistent. Few studies have assessed the relationship between obesity‐related behavioral factors, such as diet and exercise, and risk of acute respiratory infection. Objective To determine whether community prevalence of obesity, low fruit/vegetable consumption, and physical inactivity are associated with influenza‐related hospitalization rates. Methods Using data from 274 US counties, from 2002 to 2008, we regressed county influenza‐related hospitalization rates on county prevalence of obesity (BMI ≥ 30), low fruit/vegetable consumption (<5 servings/day), and physical inactivity (<30 minutes/month recreational exercise), while adjusting for community‐level confounders such as insurance coverage and the number of primary care physicians per 100 000 population. Results A 5% increase in obesity prevalence was associated with a 12% increase in influenza‐related hospitalization rates [adjusted rate ratio (ARR) 1·12, 95% confidence interval (CI) 1·07, 1·17]. Similarly, a 5% increase in the prevalence of low fruit/vegetable consumption and physical inactivity was associated with an increase of 12% (ARR 1·12, 95% CI 1·08, 1·17) and 11% (ARR 1·11, 95% CI 1·07, 1·16), respectively. When all three variables were included in the same model, a 5% increase in prevalence of obesity, low fruit/vegetable consumption, and physical inactivity was associated with 6%, 8%, and 7% increases in influenza‐related hospitalization rates, respectively. Conclusions Communities with a greater prevalence of obesity were more likely to have high influenza‐related hospitalization rates. Similarly, less physically active populations, with lower fruit/vegetable consumption, tended to have higher influenza‐related hospitalization rates, even after accounting for obesity
Adjusted rate ratios and 95% confidence intervals for comparison of most deprived to least deprived populations using influenza definition.
§<p>comparison using pooled data from 11 most and 11 least deprived neighbourhoods.</p
Rate Ratio of emergency department and outpatient clinic visits given a one unit change in deprivation score.
<p>Rate Ratio of emergency department and outpatient clinic visits given a one unit change in deprivation score.</p
Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.
<p>Neighbourhood log standardized morbidity ratio for influenza versus deprivation score with neighbourhoods in the top and bottom 15% in black.</p
Choropleth maps of neighborhood standardized morbidity ratios and deprivation scores.
<p>Standardized morbidity ratio for influenza (a), standardized morbidity ratio for pneumonia and influenza (b), Material deprivation (c), Social Deprivation (d).</p