
Socially vulnerable adults hospitalized for influenza required invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) support at greater rates than their higher-income counterparts during five respiratory virus seasons in the United States, concludes a study published in JAMA Network Open.
The Centers for Disease Control and Prevention (CDC)-led study used data from the US Census and the CDC's Influenza Hospitalization Surveillance Network of counties in 13 states to assess death rates and the use of respiratory interventions, flu vaccinations, and antiviral prescriptions among 57,964 hospitalized flu patients from 2014 to 2019.
"Influenza may disproportionately impact socially vulnerable populations, ie, people with community factors that limit disease prevention and management, such as poverty, discrimination, reduced transportation, and dense housing," the researchers noted. "Social determinants can contribute to preventable differences in disease burden and health opportunities."
Less access to vaccines, antivirals
Social vulnerability was greater for patients who were from the Western Census region (relative change from lowest to highest vulnerability, 12.0%), women (6.3%), Hispanic (339.3%), Black (504.9%), or American Indian/Alaska Native (166.7%).
Influenza may disproportionately impact socially vulnerable populations, ie, people with community factors that limit disease prevention and management, such as poverty, discrimination, reduced transportation, and dense housing.
People living in socially vulnerable areas had higher rates of invasive mechanical ventilation and/or ECMO (adjusted prevalence ratio [aPR], 1.25), primarily due to socioeconomic status (aPR, 1.31) and household composition and disability (aPR, 1.20). Receipt of these interventions was partially mediated by vaccination status, the presence of chronic conditions, and respiratory symptoms.
Among patients of all ages, the proportion of deaths dropped 16.7% as social vulnerability increased, except for those aged 18 to 49 years, in whom deaths climbed 134.3% as social vulnerability increased.
The percentage of patients receiving flu vaccines fell 19.4% with increasing social vulnerability, and the percentage vaccinated by October 31 declined 6.8%. Early in-hospital antiviral initiation and prehospital antiviral receipt decreased 1.0% and 17.3%, respectively, along with greater vulnerability.
The results support that low socioeconomic status is linked to reduced access to flu vaccines and prehospitalization antivirals and higher proportions of asthma, chronic lung disease, and more respiratory signs and symptoms, the authors said.