Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis
Identifieur interne : 000943 ( Ncbi/Checkpoint ); précédent : 000942; suivant : 000944Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis
Auteurs : Dominik Mertz [Canada] ; Tae Hyong Kim [Canada] ; Jennie Johnstone [Canada] ; Po-Po Lam [Canada] ; Michelle Science [Canada] ; Stefan P. Kuster [Suisse] ; Shaza A. Fadel [Canada] ; Dat Tran [Canada] ; Eduardo Fernandez [Canada] ; Neera Bhatnagar [Canada] ; Mark Loeb [Canada]Source :
- The BMJ [ 0959-8138 ] ; 2013.
Abstract
Url:
DOI: 10.1136/bmj.f5061
PubMed: 23974637
PubMed Central: 3805492
Affiliations:
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Kuster</name><affiliation wicri:level="1"><nlm:aff id="aff6">University Hospital and University of Zurich, Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospital and University of Zurich, Zurich</wicri:regionArea><wicri:noRegion>Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Fadel, Shaza A" sort="Fadel, Shaza A" uniqKey="Fadel S" first="Shaza A" last="Fadel">Shaza A. Fadel</name><affiliation wicri:level="4"><nlm:aff id="aff4">Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Tran, Dat" sort="Tran, Dat" uniqKey="Tran D" first="Dat" last="Tran">Dat Tran</name><affiliation wicri:level="4"><nlm:aff id="aff5">Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Fernandez, Eduardo" sort="Fernandez, Eduardo" uniqKey="Fernandez E" first="Eduardo" last="Fernandez">Eduardo Fernandez</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Bhatnagar, Neera" sort="Bhatnagar, Neera" uniqKey="Bhatnagar N" first="Neera" last="Bhatnagar">Neera Bhatnagar</name><affiliation wicri:level="4"><nlm:aff id="aff7">Health Sciences Library, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff8">Department of Pathology and Molecular Medicine, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff9">Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton</nlm:aff><orgName type="university">Université 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type="wicri:Area/Ncbi/Curation">000943</idno><idno type="wicri:Area/Ncbi/Checkpoint">000943</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis</title><author><name sortKey="Mertz, Dominik" sort="Mertz, Dominik" uniqKey="Mertz D" first="Dominik" last="Mertz">Dominik Mertz</name><affiliation wicri:level="4"><nlm:aff id="aff1">Department of Medicine, McMaster University, Hamilton, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine, McMaster University, Hamilton, ON</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Kim, Tae Hyong" sort="Kim, Tae Hyong" uniqKey="Kim T" first="Tae Hyong" last="Kim">Tae Hyong Kim</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Johnstone, Jennie" sort="Johnstone, Jennie" uniqKey="Johnstone J" first="Jennie" last="Johnstone">Jennie Johnstone</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lam, Po Po" sort="Lam, Po Po" uniqKey="Lam P" first="Po-Po" last="Lam">Po-Po Lam</name><affiliation wicri:level="1"><nlm:aff id="aff3">Mount Sinai Hospital, Toronto, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Mount Sinai Hospital, Toronto, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff4">Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Science, Michelle" sort="Science, Michelle" uniqKey="Science M" first="Michelle" last="Science">Michelle Science</name><affiliation wicri:level="4"><nlm:aff id="aff5">Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Kuster, Stefan P" sort="Kuster, Stefan P" uniqKey="Kuster S" first="Stefan P" last="Kuster">Stefan P. Kuster</name><affiliation wicri:level="1"><nlm:aff id="aff6">University Hospital and University of Zurich, Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospital and University of Zurich, Zurich</wicri:regionArea><wicri:noRegion>Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Fadel, Shaza A" sort="Fadel, Shaza A" uniqKey="Fadel S" first="Shaza A" last="Fadel">Shaza A. Fadel</name><affiliation wicri:level="4"><nlm:aff id="aff4">Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Tran, Dat" sort="Tran, Dat" uniqKey="Tran D" first="Dat" last="Tran">Dat Tran</name><affiliation wicri:level="4"><nlm:aff id="aff5">Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Fernandez, Eduardo" sort="Fernandez, Eduardo" uniqKey="Fernandez E" first="Eduardo" last="Fernandez">Eduardo Fernandez</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Bhatnagar, Neera" sort="Bhatnagar, Neera" uniqKey="Bhatnagar N" first="Neera" last="Bhatnagar">Neera Bhatnagar</name><affiliation wicri:level="4"><nlm:aff id="aff7">Health Sciences Library, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name><affiliation wicri:level="4"><nlm:aff id="aff2">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff8">Department of Pathology and Molecular Medicine, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff9">Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton</nlm:aff><orgName type="university">Université McMaster</orgName><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j">The BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1756-1833</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><bold>Objective</bold> To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza.</p><p><bold>Design</bold> Systematic review.</p><p><bold>Study selection</bold> Observational studies reporting on risk factor-outcome combinations of interest in participants with influenza. Outcomes included death, ventilator support, admission to hospital, admission to an intensive care unit, pneumonia, and composite outcomes.</p><p><bold>Data sources</bold> Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011.</p><p><bold>Risk of bias assessment</bold> Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence.</p><p><bold>Results</bold> 63 537 articles were identified of which 234 with a total of 610 782 participants met the inclusion criteria. The evidence supporting risk factors for severe outcomes of influenza ranged from being limited to absent. This was particularly relevant for the relative lack of data for non-2009 H1N1 pandemics and for seasonal influenza studies. Limitations in the published literature included lack of power and lack of adjustment for confounders was widespread: adjusted risk estimates were provided for only 5% of risk factor-outcome comparisons in 39 of 260 (15%) studies. The level of evidence was low for “any risk factor” (odds ratio for mortality 2.77, 95% confidence interval 1.90 to 4.05 for pandemic influenza and 2.04, 1.74 to 2.39 for seasonal influenza), obesity (2.74, 1.56 to 4.80 and 30.1, 1.74 to 2.39), cardiovascular diseases (2.92, 1.76 to 4.86 and 1.97, 1.06 to 3.67), and neuromuscular disease (2.68, 1.91 to 3.75 and 3.21, 1.84 to 5.58). The level of evidence was very low for all other risk factors. Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza (4.43, 1.24 to 15.81).</p><p><bold>Conclusion</bold> The level of evidence to support risk factors for influenza related complications is low and some well accepted risk factors, including pregnancy and ethnicity, could not be confirmed as risks. Rigorous and adequately powered studies are needed.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Suisse</li></country><region><li>Ontario</li></region><settlement><li>Hamilton (Ontario)</li><li>Toronto</li></settlement><orgName><li>Université McMaster</li><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Mertz, Dominik" sort="Mertz, Dominik" uniqKey="Mertz D" first="Dominik" last="Mertz">Dominik Mertz</name></region><name sortKey="Bhatnagar, Neera" sort="Bhatnagar, Neera" uniqKey="Bhatnagar N" first="Neera" last="Bhatnagar">Neera Bhatnagar</name><name sortKey="Fadel, Shaza A" sort="Fadel, Shaza A" uniqKey="Fadel S" first="Shaza A" last="Fadel">Shaza A. Fadel</name><name sortKey="Fernandez, Eduardo" sort="Fernandez, Eduardo" uniqKey="Fernandez E" first="Eduardo" last="Fernandez">Eduardo Fernandez</name><name sortKey="Johnstone, Jennie" sort="Johnstone, Jennie" uniqKey="Johnstone J" first="Jennie" last="Johnstone">Jennie Johnstone</name><name sortKey="Kim, Tae Hyong" sort="Kim, Tae Hyong" uniqKey="Kim T" first="Tae Hyong" last="Kim">Tae Hyong Kim</name><name sortKey="Lam, Po Po" sort="Lam, Po Po" uniqKey="Lam P" first="Po-Po" last="Lam">Po-Po Lam</name><name sortKey="Lam, Po Po" sort="Lam, Po Po" uniqKey="Lam P" first="Po-Po" last="Lam">Po-Po Lam</name><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name><name sortKey="Mertz, Dominik" sort="Mertz, Dominik" uniqKey="Mertz D" first="Dominik" last="Mertz">Dominik Mertz</name><name sortKey="Science, Michelle" sort="Science, Michelle" uniqKey="Science M" first="Michelle" last="Science">Michelle Science</name><name sortKey="Tran, Dat" sort="Tran, Dat" uniqKey="Tran D" first="Dat" last="Tran">Dat Tran</name></country><country name="Suisse"><noRegion><name sortKey="Kuster, Stefan P" sort="Kuster, Stefan P" uniqKey="Kuster S" first="Stefan P" last="Kuster">Stefan P. 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