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Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009–2010

Identifieur interne : 000B38 ( Pmc/Curation ); précédent : 000B37; suivant : 000B39

Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009–2010

Auteurs : Fernando González-Candelas [Espagne] ; Jenaro Astray [Espagne] ; Jordi Alonso [Espagne] ; Ady Castro [Espagne] ; Rafael Cant N [Espagne] ; Juan Carlos Galán [Espagne] ; Olatz Garin [Espagne] ; Marc Sáez [Espagne] ; Nuria Soldevila [Espagne] ; Maretva Baricot [Espagne] ; Jesús Castilla [Espagne] ; Pere Godoy [Espagne] ; Miguel Delgado-Rodríguez [Espagne] ; Vicente Martín [Espagne] ; José María Mayoral [Espagne] ; Tomás Pumarola [Espagne] ; José María Quintana [Espagne] ; Sonia Tamames [Espagne] ; Angela Domínguez [Espagne]

Source :

RBID : PMC:3296770

Abstract

The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.


Url:
DOI: 10.1371/journal.pone.0033139
PubMed: 22412995
PubMed Central: 3296770

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PMC:3296770

Le document en format XML

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<name sortKey="Castro, Ady" sort="Castro, Ady" uniqKey="Castro A" first="Ady" last="Castro">Ady Castro</name>
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<addr-line>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain</addr-line>
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<name sortKey="Galan, Juan Carlos" sort="Galan, Juan Carlos" uniqKey="Galan J" first="Juan Carlos" last="Galán">Juan Carlos Galán</name>
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<name sortKey="Garin, Olatz" sort="Garin, Olatz" uniqKey="Garin O" first="Olatz" last="Garin">Olatz Garin</name>
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<name sortKey="Saez, Marc" sort="Saez, Marc" uniqKey="Saez M" first="Marc" last="Sáez">Marc Sáez</name>
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<addr-line>Departament d'Economia, Universitat de Girona, Girona, Spain</addr-line>
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<wicri:regionArea>Departament d'Economia, Universitat de Girona, Girona</wicri:regionArea>
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<name sortKey="Soldevila, Nuria" sort="Soldevila, Nuria" uniqKey="Soldevila N" first="Nuria" last="Soldevila">Nuria Soldevila</name>
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<name sortKey="Baricot, Maretva" sort="Baricot, Maretva" uniqKey="Baricot M" first="Maretva" last="Baricot">Maretva Baricot</name>
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<name sortKey="Castilla, Jesus" sort="Castilla, Jesus" uniqKey="Castilla J" first="Jesús" last="Castilla">Jesús Castilla</name>
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<addr-line>Instituto de Salud Pública de Navarra, Pamplona, Spain</addr-line>
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<name sortKey="Godoy, Pere" sort="Godoy, Pere" uniqKey="Godoy P" first="Pere" last="Godoy">Pere Godoy</name>
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<addr-line>Departament de Salut, Generalitat de Catalunya, Barcelona, Spain</addr-line>
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<name sortKey="Delgado Rodriguez, Miguel" sort="Delgado Rodriguez, Miguel" uniqKey="Delgado Rodriguez M" first="Miguel" last="Delgado-Rodríguez">Miguel Delgado-Rodríguez</name>
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<name sortKey="Martin, Vicente" sort="Martin, Vicente" uniqKey="Martin V" first="Vicente" last="Martín">Vicente Martín</name>
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<country xml:lang="fr">Espagne</country>
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<addr-line>Instituto de Biomedicina, Universidad de León, León, Spain</addr-line>
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<name sortKey="Mayoral, Jose Maria" sort="Mayoral, Jose Maria" uniqKey="Mayoral J" first="José María" last="Mayoral">José María Mayoral</name>
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<name sortKey="Pumarola, Tomas" sort="Pumarola, Tomas" uniqKey="Pumarola T" first="Tomás" last="Pumarola">Tomás Pumarola</name>
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<name sortKey="Quintana, Jose Maria" sort="Quintana, Jose Maria" uniqKey="Quintana J" first="José María" last="Quintana">José María Quintana</name>
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<addr-line>Fundación Vasca de Innovación e Investigación Sanitarias, Sondika, Spain</addr-line>
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<name sortKey="Tamames, Sonia" sort="Tamames, Sonia" uniqKey="Tamames S" first="Sonia" last="Tamames">Sonia Tamames</name>
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<name sortKey="Dominguez, Angela" sort="Dominguez, Angela" uniqKey="Dominguez A" first="Angela" last="Domínguez">Angela Domínguez</name>
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<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
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<addr-line>Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Departament de Salut Pública, Universitat de Barcelona, Barcelona</wicri:regionArea>
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<name sortKey="Alonso, Jordi" sort="Alonso, Jordi" uniqKey="Alonso J" first="Jordi" last="Alonso">Jordi Alonso</name>
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<addr-line>Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
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<addr-line>Unitat de Recerca en Serveis Sanitaris, Institut Municipal d'Investigació Mèdica-Institut de Recerca de l'Hospital del Mar, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
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<name sortKey="Castro, Ady" sort="Castro, Ady" uniqKey="Castro A" first="Ady" last="Castro">Ady Castro</name>
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<addr-line>CIBER Enfermedades Respiratorias, Madrid, Spain</addr-line>
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<country xml:lang="fr">Espagne</country>
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<name sortKey="Cant N, Rafael" sort="Cant N, Rafael" uniqKey="Cant N R" first="Rafael" last="Cant N">Rafael Cant N</name>
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<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
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<nlm:aff id="aff7">
<addr-line>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid</wicri:regionArea>
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<name sortKey="Galan, Juan Carlos" sort="Galan, Juan Carlos" uniqKey="Galan J" first="Juan Carlos" last="Galán">Juan Carlos Galán</name>
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<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
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<nlm:aff id="aff7">
<addr-line>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid</wicri:regionArea>
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<name sortKey="Garin, Olatz" sort="Garin, Olatz" uniqKey="Garin O" first="Olatz" last="Garin">Olatz Garin</name>
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<nlm:aff id="aff5">
<addr-line>Unitat de Recerca en Serveis Sanitaris, Institut Municipal d'Investigació Mèdica-Institut de Recerca de l'Hospital del Mar, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Unitat de Recerca en Serveis Sanitaris, Institut Municipal d'Investigació Mèdica-Institut de Recerca de l'Hospital del Mar, Barcelona</wicri:regionArea>
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<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Saez, Marc" sort="Saez, Marc" uniqKey="Saez M" first="Marc" last="Sáez">Marc Sáez</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff8">
<addr-line>Departament d'Economia, Universitat de Girona, Girona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Departament d'Economia, Universitat de Girona, Girona</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Soldevila, Nuria" sort="Soldevila, Nuria" uniqKey="Soldevila N" first="Nuria" last="Soldevila">Nuria Soldevila</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Baricot, Maretva" sort="Baricot, Maretva" uniqKey="Baricot M" first="Maretva" last="Baricot">Maretva Baricot</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Castilla, Jesus" sort="Castilla, Jesus" uniqKey="Castilla J" first="Jesús" last="Castilla">Jesús Castilla</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff9">
<addr-line>Instituto de Salud Pública de Navarra, Pamplona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Instituto de Salud Pública de Navarra, Pamplona</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Godoy, Pere" sort="Godoy, Pere" uniqKey="Godoy P" first="Pere" last="Godoy">Pere Godoy</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff10">
<addr-line>Departament de Salut, Generalitat de Catalunya, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Departament de Salut, Generalitat de Catalunya, Barcelona</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Delgado Rodriguez, Miguel" sort="Delgado Rodriguez, Miguel" uniqKey="Delgado Rodriguez M" first="Miguel" last="Delgado-Rodríguez">Miguel Delgado-Rodríguez</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff11">
<addr-line>División de Medicina Preventiva y Salud Pública, Universidad de Jaén, Jaén, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>División de Medicina Preventiva y Salud Pública, Universidad de Jaén, Jaén</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Martin, Vicente" sort="Martin, Vicente" uniqKey="Martin V" first="Vicente" last="Martín">Vicente Martín</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff12">
<addr-line>Instituto de Biomedicina, Universidad de León, León, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Instituto de Biomedicina, Universidad de León, León</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Mayoral, Jose Maria" sort="Mayoral, Jose Maria" uniqKey="Mayoral J" first="José María" last="Mayoral">José María Mayoral</name>
<affiliation wicri:level="1">
<nlm:aff id="aff13">
<addr-line>Servicio de Vigilancia de Andalucía, Sevilla, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Servicio de Vigilancia de Andalucía, Sevilla</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Pumarola, Tomas" sort="Pumarola, Tomas" uniqKey="Pumarola T" first="Tomás" last="Pumarola">Tomás Pumarola</name>
<affiliation wicri:level="1">
<nlm:aff id="aff14">
<addr-line>Red Española de Investigación en Patologías Infecciosas (REIPI), Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Red Española de Investigación en Patologías Infecciosas (REIPI), Madrid</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Quintana, Jose Maria" sort="Quintana, Jose Maria" uniqKey="Quintana J" first="José María" last="Quintana">José María Quintana</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff15">
<addr-line>Fundación Vasca de Innovación e Investigación Sanitarias, Sondika, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Fundación Vasca de Innovación e Investigación Sanitarias, Sondika</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Tamames, Sonia" sort="Tamames, Sonia" uniqKey="Tamames S" first="Sonia" last="Tamames">Sonia Tamames</name>
<affiliation wicri:level="1">
<nlm:aff id="aff16">
<addr-line>Dirección General de Salud Pública, Desarrollo e Innovación, Junta de Castilla y León, Valladolid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Dirección General de Salud Pública, Desarrollo e Innovación, Junta de Castilla y León, Valladolid</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Dominguez, Angela" sort="Dominguez, Angela" uniqKey="Dominguez A" first="Angela" last="Domínguez">Angela Domínguez</name>
<affiliation wicri:level="1">
<nlm:aff id="aff2">
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER Epidemiología y Salud Pública, Madrid</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="aff17">
<addr-line>Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain</addr-line>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Departament de Salut Pública, Universitat de Barcelona, Barcelona</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series>
<title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint>
<date when="2012">2012</date>
</imprint>
</series>
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<textClass></textClass>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.</p>
</div>
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<journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
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<journal-title>PLoS ONE</journal-title>
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<issn pub-type="epub">1932-6203</issn>
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<publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, USA</publisher-loc>
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<article-id pub-id-type="pmid">22412995</article-id>
<article-id pub-id-type="pmc">3296770</article-id>
<article-id pub-id-type="publisher-id">PONE-D-11-19813</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0033139</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v2">
<subject>Biology</subject>
<subj-group>
<subject>Population Biology</subject>
<subj-group>
<subject>Epidemiology</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2">
<subject>Medicine</subject>
<subj-group>
<subject>Epidemiology</subject>
</subj-group>
<subj-group>
<subject>Infectious Diseases</subject>
<subj-group>
<subject>Viral Diseases</subject>
</subj-group>
</subj-group>
<subj-group>
<subject>Non-Clinical Medicine</subject>
</subj-group>
<subj-group>
<subject>Public Health</subject>
</subj-group>
<subj-group>
<subject>Pulmonology</subject>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2">
<subject>Social and Behavioral Sciences</subject>
<subj-group>
<subject>Sociology</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009–2010</article-title>
<alt-title alt-title-type="running-head">Hospitalization by Pandemic Influenza Infection</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>González-Candelas</surname>
<given-names>Fernando</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor1">
<sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Astray</surname>
<given-names>Jenaro</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alonso</surname>
<given-names>Jordi</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Castro</surname>
<given-names>Ady</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cantón</surname>
<given-names>Rafael</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Galán</surname>
<given-names>Juan Carlos</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Garin</surname>
<given-names>Olatz</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sáez</surname>
<given-names>Marc</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff8">
<sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Soldevila</surname>
<given-names>Nuria</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Baricot</surname>
<given-names>Maretva</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Castilla</surname>
<given-names>Jesús</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff9">
<sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Godoy</surname>
<given-names>Pere</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff10">
<sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Delgado-Rodríguez</surname>
<given-names>Miguel</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff11">
<sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Martín</surname>
<given-names>Vicente</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff12">
<sup>12</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mayoral</surname>
<given-names>José María</given-names>
</name>
<xref ref-type="aff" rid="aff13">
<sup>13</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pumarola</surname>
<given-names>Tomás</given-names>
</name>
<xref ref-type="aff" rid="aff14">
<sup>14</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Quintana</surname>
<given-names>José María</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff15">
<sup>15</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tamames</surname>
<given-names>Sonia</given-names>
</name>
<xref ref-type="aff" rid="aff16">
<sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Domínguez</surname>
<given-names>Angela</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff17">
<sup>17</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<collab>and the CIBERESP Cases and Controls in Pandemic Influenza Working Group</collab>
<xref ref-type="author-notes" rid="fn1">
<sup></sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1">
<label>1</label>
<addr-line>Unidad Mixta Genómica y Salud CSISP-Universitat de València, Valencia, Spain</addr-line>
</aff>
<aff id="aff2">
<label>2</label>
<addr-line>CIBER Epidemiología y Salud Pública, Madrid, Spain</addr-line>
</aff>
<aff id="aff3">
<label>3</label>
<addr-line>Subdirección de Vigilancia, Comunidad de Madrid, Madrid, Spain</addr-line>
</aff>
<aff id="aff4">
<label>4</label>
<addr-line>Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain</addr-line>
</aff>
<aff id="aff5">
<label>5</label>
<addr-line>Unitat de Recerca en Serveis Sanitaris, Institut Municipal d'Investigació Mèdica-Institut de Recerca de l'Hospital del Mar, Barcelona, Spain</addr-line>
</aff>
<aff id="aff6">
<label>6</label>
<addr-line>CIBER Enfermedades Respiratorias, Madrid, Spain</addr-line>
</aff>
<aff id="aff7">
<label>7</label>
<addr-line>Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain</addr-line>
</aff>
<aff id="aff8">
<label>8</label>
<addr-line>Departament d'Economia, Universitat de Girona, Girona, Spain</addr-line>
</aff>
<aff id="aff9">
<label>9</label>
<addr-line>Instituto de Salud Pública de Navarra, Pamplona, Spain</addr-line>
</aff>
<aff id="aff10">
<label>10</label>
<addr-line>Departament de Salut, Generalitat de Catalunya, Barcelona, Spain</addr-line>
</aff>
<aff id="aff11">
<label>11</label>
<addr-line>División de Medicina Preventiva y Salud Pública, Universidad de Jaén, Jaén, Spain</addr-line>
</aff>
<aff id="aff12">
<label>12</label>
<addr-line>Instituto de Biomedicina, Universidad de León, León, Spain</addr-line>
</aff>
<aff id="aff13">
<label>13</label>
<addr-line>Servicio de Vigilancia de Andalucía, Sevilla, Spain</addr-line>
</aff>
<aff id="aff14">
<label>14</label>
<addr-line>Red Española de Investigación en Patologías Infecciosas (REIPI), Madrid, Spain</addr-line>
</aff>
<aff id="aff15">
<label>15</label>
<addr-line>Fundación Vasca de Innovación e Investigación Sanitarias, Sondika, Spain</addr-line>
</aff>
<aff id="aff16">
<label>16</label>
<addr-line>Dirección General de Salud Pública, Desarrollo e Innovación, Junta de Castilla y León, Valladolid, Spain</addr-line>
</aff>
<aff id="aff17">
<label>17</label>
<addr-line>Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain</addr-line>
</aff>
<contrib-group>
<contrib contrib-type="editor">
<name>
<surname>Semple</surname>
<given-names>Malcolm Gracie</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1">University of Liverpool, United Kingdom</aff>
<author-notes>
<corresp id="cor1">* E-mail:
<email>fernando.gonzalez@uv.es</email>
</corresp>
<fn fn-type="con">
<p>Conceived and designed the experiments: FGC J. Alonso AC RC JCG OG MB JC PG MDR VM JMM TP JMQ ST AD. Performed the experiments: FGC J. Alonso AC RC JCG OG MB JC PG MDR VM JMM TP JMQ ST AD. Analyzed the data: FGC J. Astray AC OG MS NS MB AD. Wrote the paper: FGC J. Astray J. Alonso AC RC OG MS MB JC PG MDR VM JMM AD.</p>
</fn>
<fn id="fn1" fn-type="other">
<p>¶ Membership of the CIBERESP Cases and Controls in Pandemic Influenza Working Group is provided in the Acknowledgments.</p>
</fn>
</author-notes>
<pub-date pub-type="collection">
<year>2012</year>
</pub-date>
<pub-date pub-type="epub">
<day>7</day>
<month>3</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="ecorrected">
<day>16 </day>
<month>3</month>
<year>2012</year>
</pub-date>
<volume>7</volume>
<issue>3</issue>
<elocation-id>e33139</elocation-id>
<history>
<date date-type="received">
<day>3</day>
<month>10</month>
<year>2011</year>
</date>
<date date-type="accepted">
<day>4</day>
<month>2</month>
<year>2012</year>
</date>
</history>
<permissions>
<copyright-statement>González-Candelas et al.</copyright-statement>
<copyright-year>2012</copyright-year>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p>
</license>
</permissions>
<abstract>
<p>The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.</p>
</abstract>
<counts>
<page-count count="8"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>

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