OBJECTIVES: We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations. METHODS: We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada. RESULTS: During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association. CONCLUSIONS: The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.
OBJECTIVES: We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations. METHODS: We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada. RESULTS: During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association. CONCLUSIONS: The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.
Authors: Gerardo Chowell; Stefano M Bertozzi; M Arantxa Colchero; Hugo Lopez-Gatell; Celia Alpuche-Aranda; Mauricio Hernandez; Mark A Miller Journal: N Engl J Med Date: 2009-06-29 Impact factor: 91.245
Authors: Michael Jerrett; Ketan Shankardass; Kiros Berhane; W James Gauderman; Nino Künzli; Edward Avol; Frank Gilliland; Fred Lurmann; Jassy N Molitor; John T Molitor; Duncan C Thomas; John Peters; Rob McConnell Journal: Environ Health Perspect Date: 2008-06-18 Impact factor: 9.031
Authors: Henry Surendra; Ngabila Salama; Karina D Lestari; Verry Adrian; Widyastuti Widyastuti; Dwi Oktavia; Rosa N Lina; Bimandra A Djaafara; Ihsan Fadilah; Rahmat Sagara; Lenny L Ekawati; Ahmad Nurhasim; Riris A Ahmad; Aria Kekalih; Ari F Syam; Anuraj H Shankar; Guy Thwaites; J Kevin Baird; Raph L Hamers; Iqbal R F Elyazar Journal: BMJ Glob Health Date: 2022-06
Authors: Supriya Kumar; Kaitlin Piper; David D Galloway; James L Hadler; John J Grefenstette Journal: BMC Public Health Date: 2015-09-23 Impact factor: 3.295