Poor Americans are more likely to be hospitalized with complications from flu than wealthier people, a new study finds.
Low vaccination rates, packed housing and less access to regular medical care likely all play a role in boosting the risk of being in an intensive care unit, needing a respirator and dying from flu complications, said lead researcher Dr. James Hadler.
“As the neighborhood gets poorer, the rate of hospitalizations from influenza increases,” said Hadler. He is a clinical professor of epidemiology and public health at Yale School of Public Health’s CT Emerging Infections Program in New Haven, Conn.
The poorest have double the risk of being hospitalized, compared with the richest, Hadler said. “These findings apply whether you’re white, black or Asian,” he said.
People in poorer neighborhoods also had twice the odds of being in intensive care, on a respirator or dying from flu, compared to people from more affluent areas, Hadler said.
Reducing the number of new flu cases is key, he said, so that means more must be done to widen vaccination efforts in poorer areas.
“People in these neighborhoods do have lower vaccination rates than people living in wealthier areas, but that doesn’t explain all the differences in hospitalizations,” Hadler said.
He noted that, “people in poorer neighborhoods tend to live in more crowded housing and have a lot closer contact with each other, and have a higher risk of getting influenza in the first place.”
Those living in poor neighborhoods also tend to have more medical conditions, such as asthma, that can make flu more severe, Hadler pointed out.
Access to regular medical care is also a factor. Lack of regular medical care is one reason vaccination levels are low, he said.
Not having regular care also forces people to wait until their condition is so severe that they have to go to the hospital, Hadler added. “They only seek care when there’s a crisis,” he said, but earlier treatment with antiviral drugs such as Tamiflu could help people living in poor neighborhoods reduce complications.
The report was published Feb. 12 in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Hadler and colleagues used data collected over two influenza seasons. The data included 27 million people from 14 states, the study said.
People in poorer neighborhoods (where 20 percent or more lived below the federal poverty level) had double the rate of influenza hospitalization compared with people in wealthier areas (where less than 5 percent lived below the poverty level), the study showed.
Hadler said the link between poverty and flu hospitalization was the same for all ages, races and ethnic groups.
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, said, “This is an important finding, but it’s not surprising. In poor areas, people are closer together and they are more likely to spread flu person-to-person.”
Influenza has a 25 percent attack rate, which means that it requires that people be close together, exposing each other to sneezing and coughing, Siegel said.
In comparison, measles has a 90 percent attack rate, which means that it is so contagious that it can be transmitted even if only a few people come into contact with someone with the virus, Siegel said.
He agreed that limited access to care and not starting antiviral drugs soon enough also contributes to the increase in flu hospitalizations.
“In addition, there is less herd immunity in poorer neighborhoods, because fewer people are vaccinated,” he said.
Fewer than 50 percent of Americans get a flu shot each year, Siegel said. “We want everyone 6 months and older to get vaccinated every year,” he added.
For more about flu, visit the U.S. Centers for Disease Control and Prevention.
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