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Langer J, Welch VL, Moran MM, Cane A, Lopez SMC, Srivastava A, Enstone A, Sears A, Markus K, Heuser M, Kewley R, Whittle I. The Cost of Seasonal Influenza: A Systematic Literature Review on the Humanistic and Economic Burden of Influenza in Older (≥ 65 Years Old) Adults. Adv Ther 2024; 41:945-966. [PMID: 38261171 PMCID: PMC10879238 DOI: 10.1007/s12325-023-02770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adults aged ≥ 65 years contribute a large proportion of influenza-related hospitalizations and deaths due to increased risk of complications, which result in high medical costs and reduced health-related quality of life (HRQoL). Although seasonal influenza vaccines are recommended for older adults, the effectiveness of current vaccines is dependent on several factors including strain matching and recipient demographic factors. This systemic literature review aimed to explore the economic and humanistic burden of influenza in adults aged ≥ 65 years. METHODS An electronic database search was conducted to identify studies assessing the economic and humanistic burden of influenza, including influenza symptoms that impact the HRQoL and patient-related outcomes in adults aged ≥ 65 years. Studies were to be published in English and conducted in Germany, France, Spain, and Italy, the UK, USA, Canada, China, Japan, Brazil, Saudi Arabia, and South Africa. RESULTS Thirty-eight studies reported on the economic and humanistic burden of influenza in adults aged ≥ 65 years. Higher direct costs were reported for people at increased risk of influenza-related complications compared to those at low risk. Lower influenza-related total costs were found in those vaccinated with adjuvanted inactivated trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD). Older age was associated with an increased occurrence and longer duration of certain influenza symptoms. CONCLUSION Despite the limited data identified, results show that influenza exerts a high humanistic and economic burden in older adults. Further research is required to confirm findings and to identify the unmet needs of current vaccines.
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Affiliation(s)
- Jakob Langer
- Pfizer Patient & Health Impact, Lisbon, Portugal.
- Pfizer Portugal, Lagoas Park, Edifício 10, 2740-271, Porto Salvo, Portugal.
| | - Verna L Welch
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | - Mary M Moran
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | - Alejandro Cane
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | | | - Amit Srivastava
- Pfizer Emerging Markets, Vaccines Medical & Scientific Affairs, Cambridge, MA, USA
| | | | - Amy Sears
- Adelphi Values PROVE, Bollington, SK10 5JB, UK
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Wu H, Xue M, Wu C, Ding Z, Wang X, Fu T, Yang K, Lin J, Lu Q. Estimation of influenza incidence and analysis of epidemic characteristics from 2009 to 2022 in Zhejiang Province, China. Front Public Health 2023; 11:1154944. [PMID: 37427270 PMCID: PMC10328336 DOI: 10.3389/fpubh.2023.1154944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background Influenza infection causes a huge burden every year, affecting approximately 8% of adults and approximately 25% of children and resulting in approximately 400,000 respiratory deaths worldwide. However, based on the number of reported influenza cases, the actual prevalence of influenza may be greatly underestimated. The purpose of this study was to estimate the incidence rate of influenza and determine the true epidemiological characteristics of this virus. Methods The number of influenza cases and the prevalence of ILIs among outpatients in Zhejiang Province were obtained from the China Disease Control and Prevention Information System. Specimens were sampled from some cases and sent to laboratories for influenza nucleic acid testing. Random forest was used to establish an influenza estimation model based on the influenza-positive rate and the percentage of ILIs among outpatients. Furthermore, the moving epidemic method (MEM) was applied to calculate the epidemic threshold for different intensity levels. Joinpoint regression analysis was used to identify the annual change in influenza incidence. The seasonal trends of influenza were detected by wavelet analysis. Results From 2009 to 2021, a total of 990,016 influenza cases and 8 deaths were reported in Zhejiang Province. The numbers of estimated influenza cases from 2009 to 2018 were 743,449, 47,635, 89,026, 132,647, 69,218, 190,099, 204,606, 190,763, 267,168 and 364,809, respectively. The total number of estimated influenza cases is 12.11 times the number of reported cases. The APC of the estimated annual incidence rate was 23.33 (95% CI: 13.2 to 34.4) from 2011 to 2019, indicating a constant increasing trend. The intensity levels of the estimated incidence from the epidemic threshold to the very high-intensity threshold were 18.94 cases per 100,000, 24.14 cases per 100,000, 141.55 cases per 100,000, and 309.34 cases per 100,000, respectively. From the first week of 2009 to the 39th week of 2022, there were a total of 81 weeks of epidemics: the epidemic period reached a high intensity in 2 weeks, the epidemic period was at a moderate intensity in 75 weeks, and the epidemic period was at a low intensity in 2 weeks. The average power was significant on the 1-year scale, semiannual scale, and 115-week scale, and the average power of the first two cycles was significantly higher than that of the other cycles. In the period from the 20th week to the 35th week, the Pearson correlation coefficients between the time series of influenza onset and the positive rate of pathogens, including A(H3N2), A (H1N1)pdm2009, B(Victoria) and B(Yamagata), were - 0.089 (p = 0.021), 0.497 (p < 0.001), -0.062 (p = 0.109) and - 0.084 (p = 0.029), respectively. In the period from the 36th week of the first year to the 19th week of the next year, the Pearson correlation coefficients between the time series of influenza onset and the positive rate of pathogens, including A(H3N2), A (H1N1)pdm2009, B(Victoria) and B(Yamagata), were 0.516 (p < 0.001), 0.148 (p < 0.001), 0.292 (p < 0.001) and 0.271 (p < 0.001), respectively. Conclusion The disease burden of influenza has been seriously underestimated in the past. An appropriate method for estimating the incidence rate of influenza may be to comprehensively consider the influenza-positive rate as well as the percentage of ILIs among outpatients. The intensity level of the estimated incidence from the epidemic threshold to the very high-intensity threshold was calculated, thus yielding a quantitative standard for judging the influenza prevalence level in the future. The incidence of influenza showed semi-annual peaks in Zhejiang Province, including a main peak from December to January of the next year followed by a peak in summer. Furthermore, the driving factors of the influenza peaks were preliminarily explored. While the peak in summer was mainly driven by pathogens of A(H3N2), the peak in winter was alternately driven by various pathogens. Our research suggests that the government urgently needs to address barriers to vaccination and actively promote vaccines through primary care providers.
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Affiliation(s)
- Haocheng Wu
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Ming Xue
- Hangzhou Center for Disease Control and Prevention (HZCDC), Hangzhou, China
| | - Chen Wu
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Zheyuan Ding
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Xinyi Wang
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Tianyin Fu
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Ke Yang
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Junfen Lin
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
| | - Qinbao Lu
- Center for Disease Control and Prevention (Zhejiang CDC), Zhejiang, Hangzhou, China
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Jin S, Jiang C, Xia T, Gu Z, Yu H, Li J, Zheng Y, Pan H, Qiao J, Cai R, Wu H, Wang C. Age-dependent and sex-dependent differences in mortality from influenza-associated cardiovascular diseases among older adults in Shanghai, China: a population-based study. BMJ Open 2022; 12:e061068. [PMID: 36123078 PMCID: PMC9486318 DOI: 10.1136/bmjopen-2022-061068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Influenza epidemics lead to substantial morbidity and mortality among older adults. This study aimed to analyse and assess the age-specific and sex-specific differences in mortality rates for cardiovascular disease (CVD) associated with influenza in older adults. DESIGN We obtained weekly data on mortality from CVD in adults≥60 years, categorised into five age groups. We used a quasi-Poisson model and adjusted for long-term and seasonal trends and absolute humidity as confounding factors. The male-to-female ratio (M/F ratio) was an indicator for assessing sex differences. SETTING Shanghai, China. PARTICIPANT We analysed 440 107 CVD deaths in adults aged ≥60 years, including 44 913 cases positive for influenza and 1 927 487 outpatient visits for influenza-like illness from 2010 to 2019. MAIN OUTCOME MEASURES Age-specific and sex-specific excess CVD mortality rates in older adults for various combinations of CVDs and influenza viruses. RESULTS Variations were observed in the excess mortality from CVD, ischaemic heart disease (IHD) and stroke depending on the influenza types/subtypes in different age and sex categories. The ≥85 years group had the highest excess mortality rates per 100 000 persons for CVD, IHD and stroke, while influenza A (H3N2) virus accounted for the highest mortality from CVD, IHD and stroke in people aged ≥65 years. Older men had a significantly lower influenza-associated IHD mortality rate than women, with an M/F ratio of 0.77 (p<0.05). CONCLUSIONS Excess mortality rates for CVDs associated with influenza increased with age in older adults. The risk for influenza-associated IHD mortality was significantly higher in older women than men. Our findings will help implement targeted health strategies, including the promotion of influenza vaccination and early therapeutic intervention for the older population with CVD, to curb the influenza burden effectively.
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Affiliation(s)
- Shan Jin
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chenyan Jiang
- Institute of Communicable Diseases Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Tian Xia
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zhen Gu
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huiting Yu
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jing Li
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yaxu Zheng
- Institute of Communicable Diseases Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hao Pan
- Institute of Communicable Diseases Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jiaying Qiao
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Renzhi Cai
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huanyu Wu
- Institute of Communicable Diseases Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chunfang Wang
- Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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Hong TH, Lee HS, Kim NE, Lee KJ, Kim YK, An JN, Kim JH, Kim HW, Park S. Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea. J Clin Med 2022; 11:jcm11164911. [PMID: 36013150 PMCID: PMC9410240 DOI: 10.3390/jcm11164911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Long-term trends in influenza-related hospitalizations, critical care resource use, and hospital outcomes since the 2009 H1N1 influenza pandemic season have been rarely studied for adult populations. Materials and Methods: Adult patients from the Korean Health Insurance Review and Assessment Service who were hospitalized with influenza over a 10-year period (2009−2019) were analyzed. The incidence rates of hospitalization, critical care resource use, and in-hospital death were calculated using mid-year population census data. Results: In total, 300,152 hospitalized patients with influenza were identified (men, 35.7%; admission to tertiary hospitals, 9.4%). Although the age-adjusted hospitalization rate initially decreased since the 2009 H1N1 pandemic (52.61/100,000 population in 2009/2010), it began to increase again in 2013/2014 and reached a peak of 169.86/100,000 population in 2017/2018 (p < 0.001). The in-hospital mortality rate showed a similar increasing trend as the hospitalization, with a peak of 1.44/100,000 population in 2017/2018 (vs. 0.35/100,000 population in 2009/2010; p < 0.001). The high incidence rates of both hospitalization and in-hospital mortality were mainly attributable to patients aged ≥60 years. The rate of intensive care unit admission and the use of mechanical ventilation, continuous renal replacement therapy and vasopressors have also increased from the 2013/2014 season. The incidence of heart failure was the most frequent complication investigated, with a three-fold increase in the last two seasons since 2009/2010. In multivariate analysis adjusted for covariates, among hospitalized patients, type of hospitals and 2009 H1N1 pandemic season were associated with in-hospital mortality. Conclusions: We confirmed that the rates of hospitalization, critical care resource use, and in-hospital mortality by influenza have increased again in recent years. Therefore, strategies are needed to reduce infections and optimize resource use with a greater focus on older people.
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Affiliation(s)
- Tae Hwa Hong
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyung Seok Lee
- Department of Nephrology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Nam-Eun Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - Kyu Jin Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Yong Kyun Kim
- Department of Infectious Disease, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Jung Nam An
- Department of Nephrology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Joo-Hee Kim
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyung Won Kim
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence:
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