Modelling estimates of age-specific influenza-related hospitalisation and mortality in the United Kingdom

Gonçalo Matias, Robert J Taylor, François Haguinet, Cynthia Schuck-Paim, Roger L Lustig, Douglas M Fleming, Gonçalo Matias, Robert J Taylor, François Haguinet, Cynthia Schuck-Paim, Roger L Lustig, Douglas M Fleming

Abstract

Background: Influenza is rarely confirmed with laboratory testing and accurate assessment of the overall burden of influenza is difficult. We used statistical modelling methods to generate updated, granular estimates of the number/rate of influenza-attributable hospitalisations and deaths in the United Kingdom. Such data are needed on a continuing basis to inform on cost-benefit analyses of treatment interventions, including vaccination.

Methods: Weekly age specific data on hospital admissions (1997-2009) and on deaths (1997-2009) were obtained from national databases. Virology reports (1996-2009) of influenza and respiratory syncytial virus detections were provided by Public Health England. We used an expanded set of ICD-codes to estimate the burden of illness attributable to influenza which we refer to as 'respiratory disease broadly defined'. These codes were chosen to optimise the balance between sensitivity and specificity. A multiple linear regression model controlled for respiratory syncytial virus circulation, with stratification by age and the presence of comorbid risk status (conditions associated with severe influenza outcomes).

Results: In the United Kingdom there were 28,516 hospitalisations and 7163 deaths estimated to be attributable to influenza respiratory disease in a mean season, with marked variability between seasons. The highest incidence rates of influenza-attributable hospitalisations and deaths were observed in adults aged 75+ years (252/100,000 and 131/100,000 population, respectively). Influenza B hospitalisations were highest among 5-17 year olds (12/100,000 population). Of all estimated influenza respiratory deaths in 75+ year olds, 50 % occurred out of hospital, and 25 % in 50-64 year olds. Rates of hospitalisations and death due to influenza-attributable respiratory disease were increased in adults identified as at-risk.

Conclusions: Our study points to a substantial but highly variable seasonal influenza burden in all age groups, particularly affecting 75+ year olds. Effective influenza prevention or early intervention with anti-viral treatment in this age group may substantially impact the disease burden and associated healthcare costs. The high burden of influenza B hospitalisation among 5-17 year olds supports current United Kingdom vaccine policy to extend quadrivalent seasonal influenza vaccination to this age group.

Trial registration: ClinicalTrial.gov, NCT01520935.

Keywords: Elderly; Hospitalisation; Influenza; Mortality; Regression analysis; Theoretical model.

Figures

Fig. 1
Fig. 1
Seasonal hospitalisation and death rates for respiratory disease* attributable to influenza A, B and RSV. Footnote: vertical bars = 95 % confidence intervals, RSV respiratory syncytial virus *broadly defined

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