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. 2015 Aug;143(11):2399-407.
doi: 10.1017/S0950268814003276. Epub 2014 Dec 12.

Using winter 2009-2010 to assess the accuracy of methods which estimate influenza-related morbidity and mortality

M L Jackson  1 , D Peterson  1 , J C Nelson  1 , S K Greene  2 , S J Jacobsen  3 , E A Belongia  4 , R Baxter  5 , L A Jackson  1
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Using winter 2009-2010 to assess the accuracy of methods which estimate influenza-related morbidity and mortality

M L Jackson et al. Epidemiol Infect. 2015 Aug.

Abstract

We used the winter of 2009-2010, which had minimal influenza circulation due to the earlier 2009 influenza A(H1N1) pandemic, to test the accuracy of ecological trend methods used to estimate influenza-related deaths and hospitalizations. We aggregated weekly counts of person-time, all-cause deaths, and hospitalizations for pneumonia/influenza and respiratory/circulatory conditions from seven healthcare systems. We predicted the incidence of the outcomes during the winter of 2009-2010 using three different methods: a cyclic (Serfling) regression model, a cyclic regression model with viral circulation data (virological regression), and an autoregressive, integrated moving average model with viral circulation data (ARIMAX). We compared predicted non-influenza incidence with actual winter incidence. All three models generally displayed high accuracy, with prediction errors for death ranging from -5% to -2%. For hospitalizations, errors ranged from -10% to -2% for pneumonia/influenza and from -3% to 0% for respiratory/circulatory. The Serfling and virological models consistently outperformed the ARIMAX model. The three methods tested could predict incidence of non-influenza deaths and hospitalizations during a winter with negligible influenza circulation. However, meaningful mis-estimation of the burden of influenza can still result with outcomes for which the contribution of influenza is low, such as all-cause mortality.

Keywords: Influenza; modelling; statistics.

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Figures

Fig. 1.
Fig. 1.
Observed weekly incidence rates per 10 000 person-years, for (a) deaths; (b) pneumonia/influenza (PI) hospitalizations; (c) respiratory circulatory (RC) hospitalizations; (d) acute myocardial infarction (MI) hospitalizations. Grey bars indicate prediction periods.
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