流感和急性呼吸道疾病在基层医疗哨点网络中的家庭就诊情况：回顾性数据库研究（2013 - 2018年）

Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018).

作者信息

de Lusignan Simon, Sherlock Julian, Akinyemi Oluwafunmi, Pebody Richard, Elliot Alex, Byford Rachel, Yonova Ivelina, Zambon Maria, Joy Mark

机构信息

Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.

Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, NW1 2FB, UK.

出版信息

BMC Public Health. 2020 Nov 20;20(1):1748. doi: 10.1186/s12889-020-09790-3.

DOI:10.1186/s12889-020-09790-3

PMID:33218318

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7677442/

Abstract

BACKGROUND

Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases' incidence.

METHODS

We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality.

RESULTS

The IRR where there was a child < 5 years were 1·62 (1·38-1·89, p < 0·0001), 2·40 (2.04-2.83, p < 0·0001) and 4·46 (3.79-5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88-2·90, p < 0·0001), 2·97 (95%CI 2·76-3·2, p < 0·0001) and 10·32 (95%CI 10.04-10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size.

CONCLUSIONS

Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy.

摘要

背景

对流感和呼吸道感染家庭传播的直接观察有限；我们的大部分理解来自数学模型。本研究旨在确定基层医疗常规数据中流感样疾病（ILI）、下呼吸道感染（LRTI）和上呼吸道感染（URTI）的家庭发病率，并确定与疾病发病率相关的因素。

方法

我们使用英国皇家全科医师学院（RCGP）研究与监测中心（RSC）基层医疗哨点网络数据库，对流感样疾病（ILI）、下呼吸道感染（LRTI）和上呼吸道感染进行了两项为期五年的回顾性分析；一项横断面研究报告负二项式模型的发病率比（IRR），以及一项回顾性队列研究，使用共享伽马脆弱性生存模型报告风险比（HR）。我们报告了以下家庭特征：5岁以下儿童、每个额外家庭成员、性别、种族（以白人作为参照）、慢性病、怀孕情况和农村地区。

结果

对于ILI、LRTI和URTI，家中有5岁以下儿童时的发病率比分别为1.62（1.38 - 1.89，p < 0.0001）、2.40（2.04 - 2.83，p < 0.0001）和4.46（3.79 - 5.255，p < 0.0001）。与男性相比，发病率比还随着家庭规模、农村地区和就诊次数以及女性性别而增加。URTI和LRTI的家庭发病率在各年份之间变化不大，而流感的发病率则有所变化，且在疫苗效力较低的年份更高。家中有5岁以下儿童时，ILI、LRTI和URTI的风险比分别为2.34（95%置信区间1.88 - 2.90，p < 0.0001）、2.97（95%置信区间2.76 - 3.2，p < 0.0001）和10.32（95%置信区间10.04 - 10.62，p < 0.0001）。风险比随着女性性别、农村地区和家庭规模的增加而增加。