The social determinants of health and pandemic H1N1 2009 influenza severity

Am J Public Health. 2012 Aug;102(8):e51-8. doi: 10.2105/AJPH.2012.300814. Epub 2012 Jun 14.


Objectives: We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations.

Methods: We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada.

Results: During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association.

Conclusions: The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Body Mass Index
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Educational Status
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / epidemiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Pandemics*
  • Risk Factors
  • Self Report
  • Smoking / epidemiology
  • Socioeconomic Factors*
  • Young Adult


  • Antiviral Agents