Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis
Identifieur interne : 002525 ( Istex/Corpus ); précédent : 002524; suivant : 002526Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis
Auteurs : Dominik Mertz ; Tae Hyong Kim ; Jennie Johnstone ; Po-Po Lam ; Michelle Science ; Stefan P. Kuster ; Shaza A. Fadel ; Dat Tran ; Eduardo Fernandez ; Neera Bhatnagar ; Mark LoebSource :
- BMJ : British Medical Journal [ 0959-8138 ] ; 2013.
English descriptors
- Teeft :
- Adverse effects, Antiviral treatment, August, Black participants, Body mass index, Cardiovascular, Cardiovascular disease, Cardiovascular diseases, Care unit admission ventilator support, Cause hospital admission, Cause mortality, Cerebrovascular insult, Chronic lung disease, Chronic lung diseases, Cohort studies, Comorbidity, Confidence interval, Confidence intervals, Convincing evidence, Diabetes mellitus, Disease control, Elderly participants, Elderly people, Eligibility criteria, Endocrinological disease, Ethnic minority group, Ethnicity, Gastrointestinal disease, Global health, Grade methodology, Hazard ratios, Healthcare workers, Heterogeneity, High risk, Higher risk, Hospital admission, Illicit drug, Immunocompromised participants, Influenza, Influenza infection, Influenza vaccination, Intensive care unit, Laboratory confirmation, Large overlap, Liver disease, Lower risk, Lung disease, Major risk factors, Mcmaster, Mcmaster university, Molecular medicine, Native populations, Neurocognitive disease, Neurological disease, Neuromuscular, Neuromuscular disease, Ntrl, Ntrl ntrl, Odds ratio, Odds ratio trend, Odds ratios, Original studies, Original study, Other outcomes, Other risk factors, Pandemic, Pandemic influenza, Pandemic influenza seasons, Participant, Pneumonia, Poor quality, Postpartum period, Potential risk factor, Prediction intervals, Pregnancy, Pregnant women, Preterm birth, Prioritise vaccination, Prognostic factors, Publication bias, Pulmonary disease, Recommendations assessment, Relative lack, Renal disease, Reprint, Research table, Risk combination, Risk combinations, Risk comparison, Risk comparisons, Risk estimates, Risk factor, Risk factors, Risk groups, Search strategy, Seasonal influenza, Severe influenza illness, Severe outcomes, Significant differences, Small number, Statistical significance, Study design, Study groups, Study quality, Study selection, Summary estimate, Summary estimates, Supplementary appendix, Systematic review, Systematic reviews, Third trimester, Trimester, Unadjusted risk estimates, Vaccination, Ventilator, Ventilator support, Weeks post partum, White participants, World health organization, Young children.
Abstract
Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection 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. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 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). Conclusion 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.
Url:
DOI: 10.1136/bmj.f5061
Links to Exploration step
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<term>Antiviral treatment</term>
<term>August</term>
<term>Black participants</term>
<term>Body mass index</term>
<term>Cardiovascular</term>
<term>Cardiovascular disease</term>
<term>Cardiovascular diseases</term>
<term>Care unit admission ventilator support</term>
<term>Cause hospital admission</term>
<term>Cause mortality</term>
<term>Cerebrovascular insult</term>
<term>Chronic lung disease</term>
<term>Chronic lung diseases</term>
<term>Cohort studies</term>
<term>Comorbidity</term>
<term>Confidence interval</term>
<term>Confidence intervals</term>
<term>Convincing evidence</term>
<term>Diabetes mellitus</term>
<term>Disease control</term>
<term>Elderly participants</term>
<term>Elderly people</term>
<term>Eligibility criteria</term>
<term>Endocrinological disease</term>
<term>Ethnic minority group</term>
<term>Ethnicity</term>
<term>Gastrointestinal disease</term>
<term>Global health</term>
<term>Grade methodology</term>
<term>Hazard ratios</term>
<term>Healthcare workers</term>
<term>Heterogeneity</term>
<term>High risk</term>
<term>Higher risk</term>
<term>Hospital admission</term>
<term>Illicit drug</term>
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<term>Influenza</term>
<term>Influenza infection</term>
<term>Influenza vaccination</term>
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<term>Laboratory confirmation</term>
<term>Large overlap</term>
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<term>Lower risk</term>
<term>Lung disease</term>
<term>Major risk factors</term>
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<term>Mcmaster university</term>
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<term>Ntrl ntrl</term>
<term>Odds ratio</term>
<term>Odds ratio trend</term>
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<term>Other risk factors</term>
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<term>Pandemic influenza seasons</term>
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<term>Pneumonia</term>
<term>Poor quality</term>
<term>Postpartum period</term>
<term>Potential risk factor</term>
<term>Prediction intervals</term>
<term>Pregnancy</term>
<term>Pregnant women</term>
<term>Preterm birth</term>
<term>Prioritise vaccination</term>
<term>Prognostic factors</term>
<term>Publication bias</term>
<term>Pulmonary disease</term>
<term>Recommendations assessment</term>
<term>Relative lack</term>
<term>Renal disease</term>
<term>Reprint</term>
<term>Research table</term>
<term>Risk combination</term>
<term>Risk combinations</term>
<term>Risk comparison</term>
<term>Risk comparisons</term>
<term>Risk estimates</term>
<term>Risk factor</term>
<term>Risk factors</term>
<term>Risk groups</term>
<term>Search strategy</term>
<term>Seasonal influenza</term>
<term>Severe influenza illness</term>
<term>Severe outcomes</term>
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<term>Study groups</term>
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<term>Summary estimates</term>
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<term>Systematic reviews</term>
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<term>Vaccination</term>
<term>Ventilator</term>
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<front><div type="abstract">Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection 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. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 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). Conclusion 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.</div>
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<abstract>Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection 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. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 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). Conclusion 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.</abstract>
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<title-group><article-title>Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="no"><name><surname>Mertz</surname>
<given-names>Dominik</given-names>
</name>
<role>assistant professor</role>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Kim</surname>
<given-names>Tae Hyong</given-names>
</name>
<role>researcher</role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Johnstone</surname>
<given-names>Jennie</given-names>
</name>
<role>researcher</role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Lam</surname>
<given-names>Po-Po</given-names>
</name>
<role>researcher</role>
<xref ref-type="aff" rid="aff3">3</xref>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Science</surname>
<given-names>Michelle</given-names>
</name>
<role>staff physician</role>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Kuster</surname>
<given-names>Stefan P</given-names>
</name>
<role>staff physician</role>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Fadel</surname>
<given-names>Shaza A</given-names>
</name>
<role>researcher</role>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Tran</surname>
<given-names>Dat</given-names>
</name>
<role>assistant professor</role>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Fernandez</surname>
<given-names>Eduardo</given-names>
</name>
<role>researcher</role>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="no"><name><surname>Bhatnagar</surname>
<given-names>Neera</given-names>
</name>
<role>librarian</role>
<xref ref-type="aff" rid="aff7">7</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Loeb</surname>
<given-names>Mark</given-names>
</name>
<role>professor</role>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="aff" rid="aff8">8</xref>
<xref ref-type="aff" rid="aff9">9</xref>
</contrib>
<aff id="aff1"><label>1</label>
Department of Medicine, McMaster University, Hamilton, ON, Canada</aff>
<aff id="aff2"><label>2</label>
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</aff>
<aff id="aff3"><label>3</label>
Mount Sinai Hospital, Toronto, ON, Canada</aff>
<aff id="aff4"><label>4</label>
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto</aff>
<aff id="aff5"><label>5</label>
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada</aff>
<aff id="aff6"><label>6</label>
University Hospital and University of Zurich, Zurich, Switzerland</aff>
<aff id="aff7"><label>7</label>
Health Sciences Library, McMaster University, Hamilton</aff>
<aff id="aff8"><label>8</label>
Department of Pathology and Molecular Medicine, McMaster University, Hamilton</aff>
<aff id="aff9"><label>9</label>
Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton</aff>
</contrib-group>
<author-notes><corresp>Correspondence to: M Loeb Department of Pathology and Molecular Medicine, McMaster University MDCL 3203, 1200 Main St. W, Hamilton, ON, Canada L8N 3Z5 <email>loebm@mcmaster.ca</email>
</corresp>
</author-notes>
<pub-date pub-type="collection"><year>2013</year>
</pub-date>
<pub-date pub-type="epub-original"><year>2013</year>
</pub-date>
<volume>347</volume>
<volume-id pub-id-type="other">347</volume-id>
<volume-id pub-id-type="other">347</volume-id>
<elocation-id>f5061</elocation-id>
<history><date date-type="accepted"><day>22</day>
<month>July</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>© Mertz et al 2013</copyright-statement>
<copyright-year>2013</copyright-year>
<copyright-holder>Mertz et al</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/3.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
.</p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-347-bmj-f5061.pdf"></self-uri>
<abstract><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>
</abstract>
</article-meta>
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<affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada</affiliation>
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<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
<description>Correspondence to: M Loeb Department of Pathology and Molecular Medicine, McMaster University MDCL 3203, 1200 Main St. W, Hamilton, ON, Canada L8N 3Z5</description>
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<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<affiliation>University Hospital and University of Zurich, Zurich, Switzerland</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<name type="personal"><namePart type="given">Shaza A</namePart>
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<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<name type="personal"><namePart type="given">Dat</namePart>
<namePart type="family">Tran</namePart>
<affiliation>Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<name type="personal"><namePart type="given">Eduardo</namePart>
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<affiliation>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<namePart type="family">Bhatnagar</namePart>
<affiliation>Health Sciences Library, McMaster University, Hamilton</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<affiliation>Department of Pathology and Molecular Medicine, McMaster University, Hamilton</affiliation>
<affiliation>Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
<affiliation>E-mail: loebm@mcmaster.ca</affiliation>
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<abstract>Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection 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. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 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). Conclusion 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.</abstract>
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