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KMID : 0191120230380250188
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Journal of Korean Medical Science
2023 Volume.38 No. 25 p.188 ~ p.188
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All-Cause and Cause-Specific Mortality Attributable to Seasonal Influenza: A Nationwide Matched Cohort Study
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Jang Hee-Seon
Cho Jae-Lim
Cho Seong-Kyung
Lee Dong-Han
Cho Sung-Il
Koh Sang-Baek
Shin Dong-Chun
Kim Chang-Soo
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Abstract
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Background : Although influenza poses substantial mortality burden, most studies have estimated excess mortality using time-aggregated data. Here, we estimated mortality risk and population attributable fraction (PAF) attributed to seasonal influenza using individual-level data from a nationwide matched cohort.
Methods : Individuals with influenza during four consecutive influenza seasons (2013?2017) (n = 5,497,812) and 1:4 age- and sex-matched individuals without influenza (n = 20,990,683) were identified from a national health insurance database. The endpoint was mortality within 30 days after influenza diagnosis. All-cause and cause-specific mortality risk ratios (RRs) attributed to influenza were estimated. Excess mortality, mortality RR, and PAF of mortality were determined, including for underlying disease subgroups.
Results : Excess mortality rate, mortality RR, and PAF of all-cause mortality were 49.5 per 100,000, 4.03 (95% confidence interval [CI], 3.63?4.48), and 5.6% (95% CI, 4.5?6.7%). Cause-specific mortality RR (12.85; 95% CI, 9.40?17.55) and PAF (20.7%; 95% CI, 13.2?27.0%) were highest for respiratory diseases. In subgroup analysis according to underlying disorders, PAF of all-cause mortality was 5.9% (95% CI, 0.6?10.7%) for liver disease, 5.8% (95% CI, 2.9?8.5%) for respiratory disease, and 3.8% (95% CI, 1.4?6.1%) for cancer.
Conclusion : Individuals with influenza had a 4-fold higher mortality risk than individuals without influenza. Preventing seasonal influenza may lead to 5.6% and 20.7% reductions in all-cause and respiratory mortality, respectively. Individuals with respiratory disease, liver disease, and cancer may benefit from prioritization when establishing influenza prevention strategies.
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KEYWORD
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Influenza, Cause of Death, Comorbidity, Mortality, Korea
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