PDF(Pubmed)
Abstract：
BACKGROUND: Every year in Italy, influenza affects about 4 million people. Almost 5% of them are hospitalised. During peak illness, enormous pressure is placed on healthcare and economic systems. This study aims to quantify the clinical and economic burden of severe influenza during 5 epidemic seasons (2014-2019) from administrative claims data.
METHODS: Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities.
RESULTS: Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0-17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0-17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 - 4). It was higher for older individuals (≥ 65 years, 11 days, [17 - 6]) and for those with comorbidities (9 days, [16 - 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were €9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was € 4,007.
CONCLUSIONS: This retrospective study showed that during the 2014-2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient\'s outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.
METHODS: Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities.
RESULTS: Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0-17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0-17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 - 4). It was higher for older individuals (≥ 65 years, 11 days, [17 - 6]) and for those with comorbidities (9 days, [16 - 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were €9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was € 4,007.
CONCLUSIONS: This retrospective study showed that during the 2014-2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient\'s outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.
摘要：
背景：每年在意大利，流感影响约400万人。其中近5%的人住院。在疾病高峰期，医疗和经济体系面临巨大压力。本研究旨在从行政索赔数据中量化5个流行季节（2014-2019年）严重流感的临床和经济负担。
方法：对2014年10月至2019年4月诊断为流感的住院患者进行分析。从4个意大利地方卫生部门（LHU）的健康相关管理数据库（AD）中检索了临床特征和管理信息。首次入学的日期被设置为索引日期(ID)。ID后六个月的随访期被认为是并发症和再次住院的原因。同时设定了回顾期(ID前2年)来评估潜在合并症的患病率.
结果：在2,333例严重流感患者中，44.1%的成年人≥65岁，25.6%的年轻人年龄在0-17岁。46.8%有合并症(即，处于危险之中)，主要是心血管和代谢性疾病(45.3%)，和慢性病(24.7%)。住院率最高的是老年人(≥75)和年轻人(0-17)，37.6和19.5/100,000居民/年，分别。平均住院时间为8天（IQR：14-4）。年龄较大的个体更高(≥65岁，11天,[17-6])和那些有合并症的人(9天，[16-6]),p值<0.001。同样，老年人和高危人群的死亡率较高(p值<0.001).12.7%的患者发生呼吸系统并发症,心血管疾病占5.9%。与流感相关的总费用为970万欧元，其中住院占95%。47.3％的住院费用与65岁以上的个体相关，52.9％与有风险的患者相关。每位患者的平均住院费用为4,007欧元。
结论：这项回顾性研究表明，在2014-2019年意大利流感季节，极端年龄的人和那些有预先存在的医疗条件，更有可能因严重流感住院。加上并发症和衰老，它们使患者的预后恶化，并可能导致住院时间延长，从而提高医疗保健利用率和成本。我们的数据产生了关于流感负担的现实证据，有助于为公共卫生决策提供信息。
方法：对2014年10月至2019年4月诊断为流感的住院患者进行分析。从4个意大利地方卫生部门（LHU）的健康相关管理数据库（AD）中检索了临床特征和管理信息。首次入学的日期被设置为索引日期(ID)。ID后六个月的随访期被认为是并发症和再次住院的原因。同时设定了回顾期(ID前2年)来评估潜在合并症的患病率.
结果：在2,333例严重流感患者中，44.1%的成年人≥65岁，25.6%的年轻人年龄在0-17岁。46.8%有合并症(即，处于危险之中)，主要是心血管和代谢性疾病(45.3%)，和慢性病(24.7%)。住院率最高的是老年人(≥75)和年轻人(0-17)，37.6和19.5/100,000居民/年，分别。平均住院时间为8天（IQR：14-4）。年龄较大的个体更高(≥65岁，11天,[17-6])和那些有合并症的人(9天，[16-6]),p值<0.001。同样，老年人和高危人群的死亡率较高(p值<0.001).12.7%的患者发生呼吸系统并发症,心血管疾病占5.9%。与流感相关的总费用为970万欧元，其中住院占95%。47.3％的住院费用与65岁以上的个体相关，52.9％与有风险的患者相关。每位患者的平均住院费用为4,007欧元。
结论：这项回顾性研究表明，在2014-2019年意大利流感季节，极端年龄的人和那些有预先存在的医疗条件，更有可能因严重流感住院。加上并发症和衰老，它们使患者的预后恶化，并可能导致住院时间延长，从而提高医疗保健利用率和成本。我们的数据产生了关于流感负担的现实证据，有助于为公共卫生决策提供信息。
