In a study published in JAMA Network Open, it was concluded that socially vulnerable adults hospitalized for influenza required invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) support at greater rates than their higher-income counterparts during five respiratory virus seasons in the United States. The Centers for Disease Control and Prevention (CDC)-led study used data from the US Census and the CDC’s Influenza Hospitalization Surveillance Network of counties in 13 states to assess various aspects among 57,964 hospitalized flu patients from 2014 to 2019.

Uncovering the Disparities in Influenza Hospitalization by Social Vulnerability

Social Vulnerability and Its Impact

Social vulnerability was found to be greater for patients from the Western Census region (with a relative change from lowest to highest vulnerability of 12.0%), women (6.3%), Hispanic (339.3%), Black (504.9%), or American Indian/Alaska Native (166.7%). This indicates that certain groups are more prone to social vulnerability, which in turn affects their health during influenza outbreaks. People living in socially vulnerable areas had higher rates of invasive mechanical ventilation and/or ECMO. The primary reasons for this were socioeconomic status (with an adjusted prevalence ratio of 1.31) and household composition and disability (with an adjusted prevalence ratio of 1.20). Vaccination status, the presence of chronic conditions, and respiratory symptoms also played a role in the receipt of these interventions.

Death Rates and Vaccination Rates

Among patients of all ages, the proportion of deaths dropped 16.7% as social vulnerability increased. However, for those aged 18 to 49 years, deaths climbed 134.3% as social vulnerability increased. This shows a different trend among different age groups. The percentage of patients receiving flu vaccines fell 19.4% with increasing social vulnerability, and the percentage vaccinated by October 31 declined 6.8%. This highlights the reduced access to flu vaccines among socially vulnerable populations. Early in-hospital antiviral initiation and prehospital antiviral receipt also decreased with greater vulnerability. The results clearly support that low socioeconomic status is linked to reduced access to flu vaccines and prehospitalization antivirals and higher proportions of asthma, chronic lung disease, and more respiratory signs and symptoms.

Analysis and Implications

These findings have significant implications for healthcare policies and interventions. It emphasizes the need to address social determinants of health to reduce the disparities in influenza hospitalization rates. By focusing on improving access to vaccines and antivirals, as well as addressing the underlying social factors that contribute to social vulnerability, it may be possible to reduce the impact of influenza on these vulnerable populations. Additionally, further research is needed to understand the specific mechanisms through which social vulnerability affects influenza outcomes and to develop targeted interventions to address these issues.