ABSTRACT
Objective@#To systematically review the mortality burden study of influenza in mainland China.@*Method@#"influenza", "flu", "H1N1", "pandemic", "mortality", "death", "fatality", "burden", "China" and "Chinese" were used as keywords, and a systematic literature search was conducted to identify articles in three English databases (PubMed, Web of Science and Embase) and three Chinese database (CNKI, WanFang and VIP) during 1990-2018 (excluding Hong Kong, Macao and Taiwan). The language of literature was restricted to Chinese and English. The inclusion criteria were human-oriented researches with method based on population, and research indexes included mortality and excess mortality. The exclusion criteria were non-primary research materials, predictive research and research on the burden of avian influenza related deaths. A total of 17 literatures were included, and the basic information to descriptive characteristics, methodology of modeling and the corresponding results were extracted.@*Results@#All the 17 studies adopted indirect statistical models, with 14 of which adopted the regression model, and all the research index was excess mortality. All causes (16 studies), respiratory and circulatory diseases (14 studies) and pneumonia and influenza (10 studies) were the main causes of death associated with influenza. Influenza associated mortality burden in the elderly was higher, with the lowest excess mortality rates of all causes, respiratory and circulatory diseases, pneumonia and influenza being 49.57, 30.80 and 0.69 per 100 000 people, and the highest rates being 228.16, 170.20 and 30.35 per 100 000 people, respectively. In the non-elderly, the corresponding lowest rates were -0.27, -0.08 and 0.04 per 100 000 people respectively, and the highest rates were 3.63, 2.6 and 0.91 per 100 000 people, respectively. The influenza-related excess mortality was higher in the north, with a minimum of 7.8 per 100 000 and a maximum of 18.0 per 100 000, and slightly lower in the south, with a minimum of 6.11 per 100 000 and a maximum of 18.7 per 100 000. There were also differences in deaths caused by different influenza virus subtypes, with influenza A(H3N2) and influenza B virus possibly posing a heavier mortality burden.@*Conclusions@#Studies on influenza mortality burden is mainly based on indirect model and urban level in China. The mortality burden of influenza in the elderly, the northern and subtype A(H3N2) and B were more severe.
ABSTRACT
Objectives@#To understand the status of studies about influenza economic burden in mainland China and summarize their major results.@*Methods@#The words of influenza, flu, cost, economic, burden, effectiveness, benefit, utility, China, and Chinese, were used as search keywords. Journal papers published during 2000-2018 were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed, Web of science, EconLit and Cochrane Library). The language of literature was restricted to Chinese and English. A total of 23 effective documents were included, and the descriptive characteristics, research indexes and methods included in the literature were analyzed. The monetary unit used in this review is Chinese Yuan (CNY).@*Results@#The 23 study sites were mainly in the relatively developed and populous regions. The total cost per capita of laboratory-confirmed influenza,of all age-group was reported in 6 literatures, and only 4 literatures reported it in out-patients (range: 768.0-999.9 CNY), Only one study reported this indicator in inpatients (9 832.0 CNY). One literature reported the total cost per capita of influenza-like illness,, which was 205.1 CNY. And one literature reported that the direct medical cost of inpatients per capita in children under 5 years of age was 6 072.0 CNY while two literature reported this index for the elderly over 60 years of age, ranging from 14 250.0 to 19 349.1 CNY. Four articles reported the economic burden of influenza in urban and rural areas, one of which showed that the related expenses of urban influenza inpatients accounted for 31% of the average annual income, while which for the rural flow was 113%.@*Conclusion@#The average economic burden of lab-confirmed influenza case is higher than that of influenza-like illness, and there are differences in outpatient indirect expenses and inpatients direct medical expenses. The direct medical burden for the hospitalized 60-years-and-beyond influenza case group is heavier thar other age group. By region, the influenza associated individual economic burden in rural area is higher than that of urban area..