TY - JOUR
T1 - Estimates of global seasonal influenza-associated respiratory mortality
T2 - a modelling study
AU - Global Seasonal Influenza-associated Mortality Collaborator Network
AU - Iuliano, A. Danielle
AU - Roguski, Katherine M.
AU - Chang, Howard H.
AU - Muscatello, David J.
AU - Palekar, Rakhee
AU - Tempia, Stefano
AU - Cohen, Cheryl
AU - Gran, Jon Michael
AU - Schanzer, Dena
AU - Cowling, Benjamin J.
AU - Wu, Peng
AU - Kyncl, Jan
AU - Ang, Li Wei
AU - Park, Minah
AU - Redlberger-Fritz, Monika
AU - Yu, Hongjie
AU - Espenhain, Laura
AU - Krishnan, Anand
AU - Emukule, Gideon
AU - van Asten, Liselotte
AU - Pereira da Silva, Susana
AU - Aungkulanon, Suchunya
AU - Buchholz, Udo
AU - Widdowson, Marc Alain
AU - Bresee, Joseph S.
AU - Azziz-Baumgartner, Eduardo
AU - Cheng, Po Yung
AU - Dawood, Fatimah
AU - Foppa, Ivo
AU - Olsen, Sonja
AU - Haber, Michael
AU - Jeffers, Caprichia
AU - MacIntyre, C. Raina
AU - Newall, Anthony T.
AU - Wood, James G.
AU - Kundi, Michael
AU - Popow-Kraupp, Therese
AU - Ahmed, Makhdum
AU - Rahman, Mahmudur
AU - Marinho, Fatima
AU - Sotomayor Proschle, C. Viviana
AU - Vergara Mallegas, Natalia
AU - Luzhao, Feng
AU - Sa, Li
AU - Barbosa-Ramírez, Juliana
AU - Sanchez, Diana Malo
AU - Gomez, Leandra Abarca
AU - Vargas, Xiomara Badilla
AU - Acosta Herrera, a. Betsy
AU - Llanés, María Josefa
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/3/31
Y1 - 2018/3/31
N2 - Background: Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000–500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999–2015. Methods: We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65–74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods. Findings: EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243–645 832 seasonal influenza-associated respiratory deaths (4·0–8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8–16·5 per 100 000 individuals), southeast Asia (3·5–9·2 per 100 000 individuals), and among people aged 75 years or older (51·3–99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243–105 690 influenza-associated respiratory deaths occur annually. Interpretation: These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated. Funding: None.
AB - Background: Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000–500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999–2015. Methods: We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65–74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods. Findings: EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243–645 832 seasonal influenza-associated respiratory deaths (4·0–8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8–16·5 per 100 000 individuals), southeast Asia (3·5–9·2 per 100 000 individuals), and among people aged 75 years or older (51·3–99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243–105 690 influenza-associated respiratory deaths occur annually. Interpretation: These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated. Funding: None.
UR - http://www.scopus.com/inward/record.url?scp=85039048596&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(17)33293-2
DO - 10.1016/S0140-6736(17)33293-2
M3 - Article
C2 - 29248255
AN - SCOPUS:85039048596
SN - 0140-6736
VL - 391
SP - 1285
EP - 1300
JO - The Lancet
JF - The Lancet
IS - 10127
ER -