Epidemiology and Infection

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Epidemiology and Infection (2010), 138:1135-1145 Cambridge University Press
Copyright © Cambridge University Press 2010
doi:10.1017/S0950268809991506

Original Papers

Infl uenza and pneumonia

Trends for influenza and pneumonia hospitalization in the older population: age, period, and cohort effects


S. A. COHENa1a2 c1, A. C. KLASSENa3, S. AHMEDa2, E. M. AGREEa2, T. A. LOUISa4 and E. N. NAUMOVAa1

a1 Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
a2 Johns Hopkins Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health, Baltimore, MD, USA
a3 Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, USA
a4 Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA
Article author query
cohen sa [PubMed]  [Google Scholar]
klassen ac [PubMed]  [Google Scholar]
ahmed s [PubMed]  [Google Scholar]
agree em [PubMed]  [Google Scholar]
louis ta [PubMed]  [Google Scholar]
naumova en [PubMed]  [Google Scholar]

SUMMARY

Birth cohort has been shown to be related to morbidity and mortality from other diseases and conditions, yet little is known about the potential for birth cohort in its relation to pneumonia and influenza (P&I) outcomes. This issue is particularly important in older adults, who experience the highest disease burden and most severe complications from these largely preventable diseases. The objective of this analysis is to assess P&I patterns in US seniors with respect to age, time, and birth cohort. All Medicare hospitalizations due to P&I (ICD-9CM codes 480-487) were abstracted and categorized by single-year of age and influenza year. These counts were then divided by intercensal estimates of age-specific population levels extracted from the US Census Bureau to obtain age- and season-specific rates. Rates were log-transformed and linear models were used to assess the relationships in P&I rates and age, influenza year, and cohort. The increase in disease rates with age accounted for most of the variability by age and influenza season. Consistent relationships between disease rates and birth cohorts remained, even after controlling for age. Seasonal associations were stronger for influenza than for pneumonia. These findings suggest that there may be a set of unmeasured characteristics or events people of certain ages experienced contemporaneously that may account for the observed differences in P&I rates in birth cohorts. Further understanding of these circumstances and those resulting age and cohort groups most vulnerable to P&I may help to target health services towards those most at risk of disease.

(Accepted November 30 2009)

(Online publication January 08 2010)

Key Words:Epidemiology; influenza; pneumococcal infection; prevention; statistics

Correspondence:

c1 Author for correspondence: Dr S. A. Cohen, Tufts School of Medicine, Department of Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111, USA. (Email: steven_a.cohen@tufts.edu)


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