IDEAS home Printed from https://ideas.repec.org/a/plo/pcbi00/1008642.html
   My bibliography  Save this article

Health inequities in influenza transmission and surveillance

Author

Listed:
  • Casey M Zipfel
  • Vittoria Colizza
  • Shweta Bansal

Abstract

The lower an individual’s socioeconomic position, the higher their risk of poor health in low-, middle-, and high-income settings alike. As health inequities grow, it is imperative that we develop an empirically-driven mechanistic understanding of the determinants of health disparities, and capture disease burden in at-risk populations to prevent exacerbation of disparities. Past work has been limited in data or scope and has thus fallen short of generalizable insights. Here, we integrate empirical data from observational studies and large-scale healthcare data with models to characterize the dynamics and spatial heterogeneity of health disparities in an infectious disease case study: influenza. We find that variation in social and healthcare-based determinants exacerbates influenza epidemics, and that low socioeconomic status (SES) individuals disproportionately bear the burden of infection. We also identify geographical hotspots of influenza burden in low SES populations, much of which is overlooked in traditional influenza surveillance, and find that these differences are most predicted by variation in susceptibility and access to sickness absenteeism. Our results highlight that the effect of overlapping factors is synergistic and that reducing this intersectionality can significantly reduce inequities. Additionally, health disparities are expressed geographically, and targeting public health efforts spatially may be an efficient use of resources to abate inequities. The association between health and socioeconomic prosperity has a long history in the epidemiological literature; addressing health inequities in respiratory-transmitted infectious disease burden is an important step towards social justice in public health, and ignoring them promises to pose a serious threat.Author summary: Health inequities, or increased morbidity and mortality due to social factors, have been demonstrated for respiratory-transmitted infectious diseases, most recently highlighted by disparities in COVID-19 severe cases and deaths. Many potential causes of these inequities have been proposed, but they have not been compared, and we do not understand their population-scale impacts. Our understanding of these issues is further hindered by epidemiological surveillance, which has been shown to overlook areas of low socioeconomic status. Here, we combine mechanistic and statistical modeling with high volume datasets to disentangle the drivers of respiratory-transmitted disease disparities, and to estimate locations where these health inequities are most severe, using influenza as a case study. We show that low socioeconomic status individuals disproportionately bear the burden of influenza infection, and that all proposed factors are synergistic in their effect. Additionally we identify geographical hotspots of poor disease surveillance among populations of low socioeconomic status, which contribute to an underestimation of health disparities. As the divide in health inequities, driven by income inequality and systemic racism, grows wider across the United States, we highlight the need to understand the mechanisms that may be at the root of disparities, and we advocate for the prioritization of capabilities to monitor outbreaks in at-risk populations so that we may prevent exacerbation of inequities.

Suggested Citation

  • Casey M Zipfel & Vittoria Colizza & Shweta Bansal, 2021. "Health inequities in influenza transmission and surveillance," PLOS Computational Biology, Public Library of Science, vol. 17(3), pages 1-23, March.
  • Handle: RePEc:plo:pcbi00:1008642
    DOI: 10.1371/journal.pcbi.1008642
    as

    Download full text from publisher

    File URL: https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008642
    Download Restriction: no

    File URL: https://journals.plos.org/ploscompbiol/article/file?id=10.1371/journal.pcbi.1008642&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pcbi.1008642?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Paul Rutter & Oliver Mytton & Matthew Mak & Liam Donaldson, 2012. "Socio-economic disparities in mortality due to pandemic influenza in England," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 57(4), pages 745-750, August.
    2. Christopher J L Murray & Sandeep C Kulkarni & Catherine Michaud & Niels Tomijima & Maria T Bulzacchelli & Terrell J Iandiorio & Majid Ezzati, 2006. "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States," PLOS Medicine, Public Library of Science, vol. 3(9), pages 1-12, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Melissa P L Chan & Robert S Weinhold & Reuben Thomas & Julia M Gohlke & Christopher J Portier, 2015. "Environmental Predictors of US County Mortality Patterns on a National Basis," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-25, December.
    2. Emma A. Adams & Jeff Parker & Tony Jablonski & Joanne Kennedy & Fiona Tasker & Desmond Hunter & Katy Denham & Claire Smiles & Cassey Muir & Amy O’Donnell & Emily Widnall & Kate Dotsikas & Eileen Kaner, 2022. "A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19," IJERPH, MDPI, vol. 19(6), pages 1-14, March.
    3. Miller, Charlotte E. & Vasan, Ramachandran S., 2021. "The southern rural health and mortality penalty: A review of regional health inequities in the United States," Social Science & Medicine, Elsevier, vol. 268(C).
    4. Janet Currie & Hannes Schwandt & Josselin Thuilliez, 2020. "Pauvreté, Egalité, Mortalité: mortality (in)equality in France and the United States," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(1), pages 197-231, January.
    5. Bilger, Marcel & Carrieri, Vincenzo, 2013. "Health in the cities: When the neighborhood matters more than income," Journal of Health Economics, Elsevier, vol. 32(1), pages 1-11.
    6. Néstor Aldea & Dariya Ordanovich & Alberto Palloni & Diego Ramiro & Francisco Viciana, 2023. "Influence of Place of Birth on Adult Mortality: The Case of Spain," European Journal of Population, Springer;European Association for Population Studies, vol. 39(1), pages 1-22, December.
    7. Clarke, Christina A. & Miller, Tim & Chang, Ellen T. & Yin, Daixin & Cockburn, Myles & Gomez, Scarlett L., 2010. "Racial and social class gradients in life expectancy in contemporary California," Social Science & Medicine, Elsevier, vol. 70(9), pages 1373-1380, May.
    8. Daza, Sebastian & palloni, alberto, 2018. "Income Mobility, Income Inequality and Mortality in the U.S," SocArXiv gdz2a, Center for Open Science.
    9. Claudia Nau & Glenn Firebaugh, 2012. "A New Method for Determining Why Length of Life is More Unequal in Some Populations Than in Others," Demography, Springer;Population Association of America (PAA), vol. 49(4), pages 1207-1230, November.
    10. Carigiet, Erwin, 2020. "Gesundheits- und Sozialpolitik in Zeiten von Covid-19," ZögU - Zeitschrift für öffentliche und gemeinwirtschaftliche Unternehmen, Nomos Verlagsgesellschaft mbH & Co. KG, vol. 43(3), pages 267-281.
    11. Solveig A. Cunningham & Gloria L. Beckles & Jannie Nielsen, 2022. "Declines in Health and Support Between Parents and Adult Children: Insights from Diabetes," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 41(4), pages 1699-1723, August.
    12. Vladimir Shkolnikov & Evgeny Andreev & Zhen Zhang & James Oeppen & James Vaupel, 2011. "Losses of Expected Lifetime in the United States and Other Developed Countries: Methods and Empirical Analyses," Demography, Springer;Population Association of America (PAA), vol. 48(1), pages 211-239, February.
    13. Grembowski, David & Bekemeier, Betty & Conrad, Douglas & Kreuter, William, 2010. "Are local health department expenditures related to racial disparities in mortality?," Social Science & Medicine, Elsevier, vol. 71(12), pages 2057-2065, December.
    14. Alexander, Monica, 2018. "Deaths without denominators: using a matched dataset to study mortality patterns in the United States," SocArXiv q79ye, Center for Open Science.
    15. Smith, James P. & Tian, Meng & Zhao, Yaohui, 2013. "Community effects on elderly health: Evidence from CHARLS national baseline," The Journal of the Economics of Ageing, Elsevier, vol. 1, pages 50-59.
    16. Roth, Adam R. & Denney, Justin T. & Amiri, Solmaz & Amram, Ofer, 2020. "Characteristics of place and the rural disadvantage in deaths from highly preventable causes," Social Science & Medicine, Elsevier, vol. 245(C).
    17. Wesley James & Jeralynn Cossman & Julia Wolf, 2018. "Persistence of death in the United States: The remarkably different mortality patterns between America’s Heartland and Dixieland," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 39(33), pages 897-910.
    18. Shannon M. Monnat, 2020. "Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 39(5), pages 805-834, October.
    19. Linda G. Martin & Zachary Zimmer & Jinkook Lee, 2017. "Foundations of Activity of Daily Living Trajectories of Older Americans," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 72(1), pages 129-139.
    20. Mark R Cullen & Clint Cummins & Victor R Fuchs, 2012. "Geographic and Racial Variation in Premature Mortality in the U.S.: Analyzing the Disparities," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-13, April.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pcbi00:1008642. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ploscompbiol (email available below). General contact details of provider: https://journals.plos.org/ploscompbiol/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.