• Open Access

Regional variation in mortality impact of the 2009 A(H1N1) influenza pandemic in China

Authors

  • Hongjie Yu,

    1. Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    2. Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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    • These authors contributed equally to this work.
  • Luzhao Feng,

    1. Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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    • These authors contributed equally to this work.
  • Cecile G. Viboud,

    1. Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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  • David K. Shay,

    1. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Yong Jiang,

    1. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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  • Hong Zhou,

    1. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Maigeng Zhou,

    1. Center for Public Health Surveillance and Information Service, Chinese Center for Disease Control and Prevention, Beijing, China
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  • Zhen Xu,

    1. Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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  • Nan Hu,

    1. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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  • Weizhong Yang,

    1. Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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  • Shaofa Nie

    Corresponding author
    1. Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • Correspondence: Shaofa Nie, Department of Epidemiology and Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China. E-mail: sf_nie@mails.tjmu.edu.cn

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Abstract

Background

Laboratory-confirmed deaths grossly underestimate influenza mortality burden, so that reliable burden estimates are derived from indirect statistical studies, which are scarce in low- and middle-income settings.

Objectives

Here, we used statistical excess mortality models to estimate the burden of seasonal and pandemic influenza in China.

Methods

We modeled data from a nationally representative population-based death registration system, combined with influenza virological surveillance data, to estimate influenza-associated excess mortality for the 2004–2005 through 2009–2010 seasons, by age and region.

Results

The A(H1N1) pandemic was associated with 11·4–12·1 excess respiratory and circulatory (R&C) deaths per 100 000 population in rural sites of northern and southern China during 2009–2010; these rates were 2·2–2·8 times higher than those of urban sites (< 0·01). Influenza B accounted for a larger proportion of deaths than pandemic A(H1N1) in 2009–2010 in some regions. Nationally, we attribute 126 200 (95% CI, 61 000–248 400) excess R&C deaths (rate of 9·4/100 000) and 2 323 000 (1 166 000–4 533 000) years of life lost (YLL) to the first year of A(H1N1)pdm circulation.

Conclusions

The A(H1N1) pandemic posed a mortality and YLL burden comparable to that of interpandemic influenza in China. Our high burden estimates in rural areas highlight the need to enhance epidemiological surveillance and healthcare services, in underdeveloped and remote areas.

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