Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

Global Seasonal Influenza-associated Mortality Collaborator Network

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

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 Previous estimates of 250 000–500 000 annual influenza deaths are outdated.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.

Original languageEnglish
Pages (from-to)1285-1300
Number of pages16
JournalThe Lancet
Volume391
Issue number10127
DOIs
Publication statusPublished - 2018 Mar 31

Fingerprint

Human Influenza
Mortality
Respiratory Tract Infections
Linear Models
Health Priorities
Southeastern Asia
Death Certificates
Africa South of the Sahara
Population
Cause of Death
Decision Making

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Global Seasonal Influenza-associated Mortality Collaborator Network (2018). Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet, 391(10127), 1285-1300. https://doi.org/10.1016/S0140-6736(17)33293-2

Estimates of global seasonal influenza-associated respiratory mortality : a modelling study. / Global Seasonal Influenza-associated Mortality Collaborator Network.

In: The Lancet, Vol. 391, No. 10127, 31.03.2018, p. 1285-1300.

Research output: Contribution to journalArticle

Global Seasonal Influenza-associated Mortality Collaborator Network 2018, 'Estimates of global seasonal influenza-associated respiratory mortality: a modelling study', The Lancet, vol. 391, no. 10127, pp. 1285-1300. https://doi.org/10.1016/S0140-6736(17)33293-2
Global Seasonal Influenza-associated Mortality Collaborator Network. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet. 2018 Mar 31;391(10127):1285-1300. https://doi.org/10.1016/S0140-6736(17)33293-2
Global Seasonal Influenza-associated Mortality Collaborator Network. / Estimates of global seasonal influenza-associated respiratory mortality : a modelling study. In: The Lancet. 2018 ; Vol. 391, No. 10127. pp. 1285-1300.
@article{5ea2bbad384845eda9caea70c70c4666,
title = "Estimates of global seasonal influenza-associated respiratory mortality: a modelling study",
abstract = "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.",
author = "{Global Seasonal Influenza-associated Mortality Collaborator Network} and Iuliano, {A. Danielle} and Roguski, {Katherine M.} and Chang, {Howard H.} and Muscatello, {David J.} and Rakhee Palekar and Stefano Tempia and Cheryl Cohen and Gran, {Jon Michael} and Dena Schanzer and Cowling, {Benjamin J.} and Peng Wu and Jan Kyncl and Ang, {Li Wei} and Minah Park and Monika Redlberger-Fritz and Hongjie Yu and Laura Espenhain and Anand Krishnan and Gideon Emukule and {van Asten}, Liselotte and {Pereira da Silva}, Susana and Suchunya Aungkulanon and Udo Buchholz and Widdowson, {Marc Alain} and Bresee, {Joseph S.} and Eduardo Azziz-Baumgartner and Cheng, {Po Yung} and Fatimah Dawood and Ivo Foppa and Sonja Olsen and Michael Haber and Caprichia Jeffers and MacIntyre, {C. Raina} and Newall, {Anthony T.} and Wood, {James G.} and Michael Kundi and Therese Popow-Kraupp and Makhdum Ahmed and Mahmudur Rahman and Fatima Marinho and {Sotomayor Proschle}, {C. Viviana} and {Vergara Mallegas}, Natalia and Feng Luzhao and Li Sa and Juliana Barbosa-Ram{\'i}rez and Sanchez, {Diana Malo} and Gomez, {Leandra Abarca} and Vargas, {Xiomara Badilla} and {Acosta Herrera}, {a. Betsy} and Kim, {Woo Joo}",
year = "2018",
month = "3",
day = "31",
doi = "10.1016/S0140-6736(17)33293-2",
language = "English",
volume = "391",
pages = "1285--1300",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10127",

}

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 - Kim, Woo Joo

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

UR - http://www.scopus.com/inward/citedby.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

VL - 391

SP - 1285

EP - 1300

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10127

ER -