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dc.contributor.authorMamelund, Svenn-Erik
dc.contributor.authorShelley-Egan, Clare
dc.contributor.authorRøgeberg, Ole
dc.date.accessioned2021-11-03T15:36:26Z
dc.date.available2021-11-03T15:36:26Z
dc.date.created2021-09-07T22:20:45Z
dc.date.issued2021-09-07
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/11250/2827688
dc.description.abstractBackground: The objective of this study is to document whether and to what extent there is an association between socioeconomic status (SES) and disease outcomes in the last five influenza pandemics. Methods/principle findings: The review included studies published in English, Danish, Norwegian and Swedish. Records were identified through systematic literature searches in six databases. We summarized results narratively and through meta-analytic strategies. Only studies for the 1918 and 2009 pandemics were identified. Of 14 studies on the 2009 pandemic including data on both medical and social risk factors, after controlling for medical risk factors 8 demonstrated independent impact of SES. In the random effect analysis of 46 estimates from 35 studies we found a pooled mean odds ratio of 1.4 (95% CI: 1.2–1.7, p < 0.001), comparing the lowest to the highest SES, but with substantial effect heterogeneity across studies,–reflecting differences in outcome measures and definitions of case and control samples. Analyses by pandemic period (1918 or 2009) and by level of SES measure (individual or ecological) indicated no differences along these dimensions. Studies using healthy controls tended to document that low SES was associated with worse influenza outcome, and studies using infected controls find low SES associated with more severe outcomes. A few studies compared severe outcomes (ICU or death) to hospital admissions but these did not find significant SES associations in any direction. Studies with more unusual comparisons (e.g., pandemic vs seasonal influenza, seasonal influenza vs other patient groups) reported no or negative non-significant associations. Conclusions/significance: We found that SES was significantly associated with pandemic influenza outcomes with people of lower SES having the highest disease burden in both 1918 and 2009. To prepare for future pandemics, we must consider social vulnerability. The protocol for this study has been registered in PROSPERO (ref. no 87922) and has been published Mamelund et al. (2019).en_US
dc.description.sponsorshipThis research is part of the project PANRISK: Socioeconomic risk groups, vaccination and pandemic influenza, funded by a research grant from the Research Council of Norway (grant agreement No. 302336).en_US
dc.language.isoengen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.ispartofseriesPLOS ONE;16(9): e0244346
dc.relation.urihttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244346
dc.rightsNavngivelse 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/deed.no*
dc.subjectPandemicsen_US
dc.subjectInfluenzaen_US
dc.subjectMedical risk factorsen_US
dc.subjectSocioeconomic health aspectsen_US
dc.subjectDeath ratesen_US
dc.subjectSchoolsen_US
dc.subjectInfectious disease controlen_US
dc.titleThe association between socioeconomic status and pandemic influenza: Systematic review and meta-analysisen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.rights.holder© 2021 Mamelund et al.en_US
dc.source.articlenumbere0244346en_US
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1
dc.identifier.doihttps://doi.org/10.1371/journal.pone.0244346
dc.identifier.cristin1932199
dc.source.journalPLOS ONEen_US
dc.source.volume16en_US
dc.source.issue9en_US
dc.source.pagenumber1-31en_US
dc.relation.projectNorges forskningsråd: 302336en_US


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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal