Urban Inner-City Minority New Yorkers Hospitalized With Novel Swine-Origin Influenza A H1N1 Virus Illness During The Pandemic Of April – June 2009

Abstract

Background: New York City (NYC) was an epicenter in 2009 of a novel SOIV illness outbreak in the US. Due to barriers to early care and prevalence of health risks, severity among urban inner-city minority patients is greater. Disparities of severity and outcomes have been described based on age and co-morbidity. We report the 2009 SOIV illness characteristics and comparison between young and older urban minority New Yorkers during the 2009 pandemic. Methods: A retrospective study of SOIV-illness among inner-city minority New Yorkers hospitalized in a city-hospital setting at South Bronx was conducted. Two hundred and ninety eight individuals had a positive screening rapid influenza antigen diagnostic (RIDT) test. Among them, 40 adults (> 18 years age) and 40 children were hospitalized with SOIV illness. Results: All study patients were urban New Yorkers of Hispanic (75%) or African American background (25%). Fourteen tested RIDT +, 5 had polymerase chain reaction (PCR) + and 61 had both positive. Adults SOIV illness were mostly young (median age 44.5 years), but among children there was no age predilection. Frequent co-morbidities (75% in adults & 47.5% in children) such as chronic airway disease, diabetes and obesity were noted. Adults requiring intensive care (37.5%) had higher prevalence of diabetes, were severely ill on admission ( median SOFA & APACHE-II scores 13 & 31 respectively), had greater length of stay (median 6 days) and significant mortality (26.6 %). Only adults had organ dysfunction (42.5%). About 10% of adults died who mostly were young and obese. Compared to adults, children had less severe SOIV illness not associated with death, intensive care admission or organ dysfunction. Conclusion: This is the first detailed study of hospitalized pediatric and adult New Yorkers highlighting age-related health disparities due to 2009 SOIV illness among urban inner-city ethnic minority. In order to provide early and effective care to SOIV-infected inner-city patients and optimize outcomes, health-care providers should be aware of clinical risks and differences in disease characteristics within this population.