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Published on: September 7, 2017
[The mortality burden of influenza in China: a systematic review]
1Changping District Center for Disease Control and Prevention, Beijing 102200, China.
Insights
This review found that influenza mortality burden in China disproportionately affects the elderly, northern regions, and specific strains like A(H3N2) and B. Most studies used indirect models to assess excess deaths.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Influenza poses a significant public health challenge globally and in China.
- Understanding the mortality burden of influenza is crucial for targeted interventions.
- Previous studies on influenza mortality in China have varied in scope and methodology.
Purpose of the Study:
- To systematically review and synthesize the existing literature on the mortality burden of influenza in mainland China.
- To identify key demographic, geographic, and viral factors associated with influenza-related deaths.
- To provide a comprehensive overview of influenza's impact on mortality in China from 1990-2018.
Main Methods:
- A systematic literature search was conducted across major English and Chinese databases (PubMed, Web of Science, Embase, CNKI, WanFang, VIP).
- Keywords included "influenza", "flu", "H1N1", "pandemic", "mortality", "death", "fatality", "burden", "China", and "Chinese".
- Studies published between 1990 and 2018, focusing on human populations and reporting mortality or excess mortality, were included. Excluded were non-primary research, predictive studies, and avian influenza deaths.
Main Results:
- All 17 included studies utilized indirect statistical models, predominantly regression models, to assess excess mortality.
- The primary causes of influenza-associated death were all causes (16 studies), respiratory and circulatory diseases (14 studies), and pneumonia and influenza (10 studies).
- The elderly experienced a higher mortality burden. Influenza A(H3N2) and B viruses were associated with a heavier burden. Mortality was higher in northern China compared to the south.
Conclusions:
- Influenza mortality studies in China primarily rely on indirect modeling and urban-level data.
- The elderly, northern regions, and specific influenza subtypes (A(H3N2), B) bear a more severe mortality burden.
- Findings highlight the need for age-specific, geographically tailored, and strain-aware influenza prevention and control strategies in China.
Abstract:
Objective: To systematically review the mortality burden study of influenza in mainland China. Method: "influenza", "flu", "H1N1", "pandemic", "mortality", "death", "fatality", "burden", "China" and "Chinese" were used as keywords, and a systematic literature search was conducted to identify articles in three English databases (PubMed, Web of Science and Embase) and three Chinese database (CNKI, WanFang and VIP) during 1990-2018 (excluding Hong Kong, Macao and Taiwan). The language of literature was restricted to Chinese and English. The inclusion criteria were human-oriented researches with method based on population, and research indexes included mortality and excess mortality. The exclusion criteria were non-primary research materials, predictive research and research on the burden of avian influenza related deaths. A total of 17 literatures were included, and the basic information to descriptive characteristics, methodology of modeling and the corresponding results were extracted. Results: All the 17 studies adopted indirect statistical models, with 14 of which adopted the regression model, and all the research index was excess mortality. All causes (16 studies), respiratory and circulatory diseases (14 studies) and pneumonia and influenza (10 studies) were the main causes of death associated with influenza. Influenza associated mortality burden in the elderly was higher, with the lowest excess mortality rates of all causes, respiratory and circulatory diseases, pneumonia and influenza being 49.57, 30.80 and 0.69 per 100 000 people, and the highest rates being 228.16, 170.20 and 30.35 per 100 000 people, respectively. In the non-elderly, the corresponding lowest rates were -0.27, -0.08 and 0.04 per 100 000 people respectively, and the highest rates were 3.63, 2.6 and 0.91 per 100 000 people, respectively. The influenza-related excess mortality was higher in the north, with a minimum of 7.8 per 100 000 and a maximum of 18.0 per 100 000, and slightly lower in the south, with a minimum of 6.11 per 100 000 and a maximum of 18.7 per 100 000. There were also differences in deaths caused by different influenza virus subtypes, with influenza A(H3N2) and influenza B virus possibly posing a heavier mortality burden. Conclusions: Studies on influenza mortality burden is mainly based on indirect model and urban level in China. The mortality burden of influenza in the elderly, the northern and subtype A(H3N2) and B were more severe.
