Abstract
BackgroundThere 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).MethodUsing 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.ResultsDeprivation 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).ConclusionThough 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.
Highlights
Defining subpopulations that initiate and promote influenza epidemics can help to guide the strategic distribution of prevention and control efforts
The correlation between the neighbourhood-level log standardized morbidity ratio (SMR) and the material and social deprivation score was 0.11 and 20.48, respectively. This finding is reflected in the choropleth maps (Figure 1), where areas with greater levels of social deprivation tended to have smaller standardized morbidity ratios (SMR)
The results of the ecological regression indicated an average decrease in utilization rates by approximately 21% for every 1 unit increase in social deprivation score (Table 1)
Summary
Defining subpopulations that initiate and promote influenza epidemics can help to guide the strategic distribution of prevention and control efforts. Deprived populations may experience higher rates of acute respiratory infection Research in this area is largely dominated by studies of hospitalizations and mortality [4,5,6] providing evidence that rates of severe illness and not necessarily rates of infection are elevated in this population [4,5,6,7,8,9,10]. Results from studies examining the impact of certain aspects of social deprivation (e.g. social support) on hospitalizations for acute respiratory illness are mixed, finding either a positive relationship or no relationship with admission rates [6] [9]. 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)
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