1918 Influenza Outcomes among Institutionalized Norwegian Populations: Implications for Disability-Inclusive Pandemic Preparedness

Dimka, Jessica; Mamelund, Svenn-Erik

doi:10.16993/sjdr.725

Cited by 13 publications

(14 citation statements)

References 49 publications

(71 reference statements)

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“…However, none of the 6 studies documenting significant associations with a higher pandemic disease burden for lower SES groups included data to control for medical risk factors. Hence, some or all of the identified associations between SES and the pandemic outcomes in the 6 above mentioned studies could potentially have been “explained away” by controlling for having latent tuberculosis [ 65 ] or other known comorbidities [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

The association between socioeconomic status and pandemic influenza: Systematic review and meta-analysis

Mamelund¹,

Shelley-Egan²,

Røgeberg

2021

PLoS ONE

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Background The objective of this study is to document whether and to what extent there is an association between socioeconomic status (SES) and disease outcomes in the last five influenza pandemics. Methods/principle findings The review included studies published in English, Danish, Norwegian and Swedish. Records were identified through systematic literature searches in six databases. We summarized results narratively and through meta-analytic strategies. Only studies for the 1918 and 2009 pandemics were identified. Of 14 studies on the 2009 pandemic including data on both medical and social risk factors, after controlling for medical risk factors 8 demonstrated independent impact of SES. In the random effect analysis of 46 estimates from 35 studies we found a pooled mean odds ratio of 1.4 (95% CI: 1.2–1.7, p < 0.001), comparing the lowest to the highest SES, but with substantial effect heterogeneity across studies,–reflecting differences in outcome measures and definitions of case and control samples. Analyses by pandemic period (1918 or 2009) and by level of SES measure (individual or ecological) indicated no differences along these dimensions. Studies using healthy controls tended to document that low SES was associated with worse influenza outcome, and studies using infected controls find low SES associated with more severe outcomes. A few studies compared severe outcomes (ICU or death) to hospital admissions but these did not find significant SES associations in any direction. Studies with more unusual comparisons (e.g., pandemic vs seasonal influenza, seasonal influenza vs other patient groups) reported no or negative non-significant associations. Conclusions/significance We found that SES was significantly associated with pandemic influenza outcomes with people of lower SES having the highest disease burden in both 1918 and 2009. To prepare for future pandemics, we must consider social vulnerability. The protocol for this study has been registered in PROSPERO (ref. no 87922) and has been published Mamelund et al. (2019).

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Section: Resultsmentioning

confidence: 99%

The association between socioeconomic status and pandemic influenza: Systematic review and meta-analysis

Mamelund¹,

Shelley-Egan²,

Røgeberg

2021

PLoS ONE

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“…However, none of the 6 studies documenting significant expected associations with a higher pandemic risk for lower SES had data to control for medical risk factors. Hence, some or all of the identified associations between SES and the pandemic outcomes in the 6 above mentioned studies could potentially have been “explained away” by controlling for having latent tuberculosis (65) or other known comorbidities (66).…”

Section: Resultsmentioning

confidence: 99%

The association between socioeconomic status and pandemic influenza: systematic review and meta-analysis

Mamelund

Shelley-Egan

Røgeberg

2020

Preprint

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BackgroundThe objective was to document whether and to what extent there was an association between socioeconomic status (SES) and disease outcomes in the last five influenza pandemics.Methods/Principle FindingsThe review included studies published in English, Danish, Norwegian and Swedish. Records were identified through systematic literature searches in six databases. Results are summarized narratively and using meta-analytic strategies. We found studies only for the 1918 and 2009 pandemics. Of 14 studies on the 2009 pandemic including data on both medical and social risk factors, after controlling for medical risk factors 8 demonstrated independent impact of SES. A random effect analysis of 46 estimates from 35 studies found a pooled mean odds ratio of 1.4 (95% CI: 1.2 – 1.7), comparing the lowest to the highest SES, but with substantial effect heterogeneity across studies –reflecting differences in outcome measures and definitions of case and control samples. Analyses by pandemic period (1918 or 2009) and by level of SES measure (individual or ecological) indicate no differences along these dimensions. Studies using healthy controls tend to find low SES associated with worse influenza outcome, and studies using infected controls find low SES associated with more severe outcomes. Studies comparing severe outcomes (ICU or death) to hospital admissions are few but indicate no clear association. Studies with more unusual comparisons (e.g., pandemic vs seasonal influenza, seasonal influenza vs other patient groups) report no or negative associations.Conclusions/SignificanceResults show that social risk factors help to explain pandemic outcomes in 1918 and in 2009 although the mechanisms and types of social vulnerabilities leading to disparities in outcomes may differ over time. Studies of the 2009 pandemic also showed that social vulnerability could not always be explained by medical risk factors. To prepare for future pandemics, we must consider social along with medical vulnerability.The protocol for this study has been registered in PROSPERO (ref. no 87922) and has been published (1).

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“…As with other health conditions, there is a dearth of studies considering disability as a risk factor during the 1918 pandemic. Using the same Norwegian data source as above, Dimka and Mamelund ( 2020 ) showed a similar morbidity‐mortality crossover when comparing (presumed nondisabled) staff to resident patients at psychiatric institutions. High morbidity and mortality levels were also suggested by records of Norwegian schools for children with disabilities, although data were insufficient for statistical analyses (Dimka & Mamelund, 2020 ).…”

Section: Evidence Of Morbidity and Mortality Disparitiesmentioning

confidence: 88%

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Dimka¹,

Doren

Battles

2022

American Journal of Biological Anthropology

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Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

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1918 Influenza Outcomes among Institutionalized Norwegian Populations: Implications for Disability-Inclusive Pandemic Preparedness

Cited by 13 publications

References 49 publications

The association between socioeconomic status and pandemic influenza: Systematic review and meta-analysis

The association between socioeconomic status and pandemic influenza: Systematic review and meta-analysis

The association between socioeconomic status and pandemic influenza: systematic review and meta-analysis

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

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