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. 2019 Jun 24;9(6):e025276.
doi: 10.1136/bmjopen-2018-025276.

National retrospective cohort study to identify age-specific fatality risks of comorbidities among hospitalised patients with influenza-like illness in Taiwan

Ting-Chia Weng #  1 , Han-Yi Robert Chiu #  2   3 , Shey-Ying Chen  3   4 , Fuh-Yuan Shih  3 , Chwan-Chuen King  4 , Cheng-Chung Fang  3
Affiliations

National retrospective cohort study to identify age-specific fatality risks of comorbidities among hospitalised patients with influenza-like illness in Taiwan

Ting-Chia Weng et al. BMJ Open. .

Abstract

Objectives: This study aimed to examine comprehensively the prognostic impact of underlying comorbidities among hospitalised patients with influenza-like illness (ILI) in different age groups and provide recommendations targeting the vulnerable patients.

Setting and participants: A retrospective cohort of 83 227 hospitalised cases with ILI were identified from Taiwan's National Health Insurance Research Database from January 2005 to December 2010. Cases were stratified into three different age groups: paediatric (0-17 years), adult (18-64 years) and elderly (≧65 years), and their age, sex, comorbidity and past healthcare utilisation were analysed for ILI-associated fatality.

Main outcome measures: ORs for ILI-related fatality in different age groups were performed using multivariable analyses with generalised estimating equation models and adjusted by age, sex and underlying comorbidities.

Results: Hospitalised ILI-related fatality significantly increased with comorbidities of cancer with metastasis (adjusted OR (aOR)=3.49, 95% CI: 3.16 to 3.86), haematological malignancy (aOR=3.02, 95% CI: 2.43 to 3.74), cancer without metastasis (aOR=1.72, 95% CI: 1.54 to 1.91), cerebrovascular (aOR=1.24, 95% CI: 1.15 to 1.33) and heart diseases (aOR=1.19, 95% CI: 1.11 to 1.27) for all age groups. Adult patients with AIDS; adult and elderly patients with chronic kidney disease, tuberculosis and diabetes were significantly associated with elevated risk of death. Severe liver diseases and hypothyroidism among elderly, and dementia/epilepsy among elderly and paediatrics were distinctively associated with likelihood of ILI-related fatality.

Conclusions: Different age-specific comorbidities were associated with increasing risk of death among hospitalised ILI patients. These findings may help update guidelines for influenza vaccination and other prevention strategies in high-risk groups for minimising worldwide ILI-related deaths.

Keywords: age; comorbidity; influenza-like illness; prognosis; public health policy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the selection process of the study population. ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; ILI, influenza-like illness; NHIRD, National Health Insurance Research Database in Taiwan.
Figure 2
Figure 2
Adjusted OR (aOR) of death in admitted patients with influenza-like illness among the three age groups and all patients in Taiwan, 1 January 2005 to 31 December 2010. CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; PVD, peripheral vascular disease.
See this image and copyright information in PMC

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