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American Journal of Epidemiology Advance Access published online on January 4, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj040
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received January 27, 2005
Accepted September 19, 2005

ORIGINAL CONTRIBUTIONS

Patterns of Influenza-associated Mortality among US Elderly by Geographic Region and Virus Subtype, 1968-1998

Sharon K. Greene 1 *, Edward L. Ionides 2, and Mark L. Wilson 1

1 Department of Epidemiology, University of Michigan, Ann Arbor, MI
2 Department of Statistics, University of Michigan, Ann Arbor, MI

* To whom correspondence should be addressed.
Sharon K. Greene, E-mail: SGreene1{at}cdc.gov


  Abstract

The regular seasonality of influenza in temperate countries is recognized, but regional differences in patterns of influenza-related mortality are poorly understood. Identifying patterns could improve epidemic prediction and prevention. The authors analyzed the monthly percentage of deaths attributable to pneumonia and influenza among people aged 65 or more years in the contiguous United States, 1968-1998. The local Moran's I test for spatial autocorrelation and correlograms assessing space-time synchrony within each influenza season were applied to detect and to characterize mortality patterns. Western US regions experienced epidemics of greater magnitude than did eastern regions. Positive spatial autocorrelation (two-sided p = 0.001) revealed the similarity in influenza mortality of neighboring states, with several western states forming a focus of high mortality. In transmission seasons dominated by virus subtype A(H3N2), mortality was correlated at a high and consistent level across the United States (mean correlation = 0.56, standard deviation = 0.134). However, when subtype A(H1N1) or type B dominated, the average synchrony was lower (mean correlation = 0.23, standard deviation = 0.058). These novel analyses suggest that causes of spatial heterogeneity (e.g., large-scale environmental drivers and population movement) have impacted influenza-associated mortality.

Keywords: climate; communicable diseases; environment and public health; influenza; mortality; National Center for Health Statistics (U.S.); space-time clustering.
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