Health disparities in past influenza pandemics: A scoping review of the literature

Angela D'Adamo; Alina Schnake-Mahl; Pricila H Mullachery; Mariana Lazo; Ana V Diez Roux; Usama Bilal

doi:10.1016/j.ssmph.2022.101314

Health disparities in past influenza pandemics: A scoping review of the literature

SSM Popul Health. 2023 Mar:21:101314. doi: 10.1016/j.ssmph.2022.101314. Epub 2022 Dec 9.

Authors

Angela D'Adamo^{1

2}, Alina Schnake-Mahl^{3

4}, Pricila H Mullachery^{3

5}, Mariana Lazo^{3

6}, Ana V Diez Roux^{3

7}, Usama Bilal^{3

7}

Affiliations

¹ Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
⁴ Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
⁵ Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelpha, PA, USA.
⁶ Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
⁷ Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.

Abstract

Objective: The COVID-19 pandemic has exacerbated existing health disparities. To provide a historical perspective on health disparities for pandemic acute respiratory viruses, we conducted a scoping review of the public health literature of health disparities in influenza outcomes during the 1918, 1957, 1968, and 2009 influenza pandemics.

Methods: We searched for articles examining socioeconomic or racial/ethnic disparities in any population, examining any influenza-related outcome (e.g., incidence, hospitalizations, mortality), during the 1918, 1957, 1968, and 2009 influenza pandemics. We conducted a structured search of English-written articles in PubMed supplemented by a snowball of articles meeting inclusion criteria.

Results: A total of 29 articles met inclusion criteria, all but one focusing exclusively on the 1918 or 2009 pandemics. Individuals of low socioeconomic status, or living in low socioeconomic status areas, experienced higher incidence, hospitalizations, and mortality in the 1918 and 2009 pandemics. There were conflicting results regarding racial/ethnic disparities during the 1918 pandemic, with differences in magnitude and direction by outcome, potentially due to issues in data quality by race/ethnicity. Racial/ethnic minorities had generally higher incidence, mortality, and hospitalization rates in the 1957 and 2009 pandemics.

Conclusion: Individuals of low socioeconomic status and racial/ethnic minorities have historically experienced worse influenza outcomes during pandemics. These historical patterns can inform current research to understand disparities in the ongoing COVID-19 pandemic and future pandemics.

Keywords: Ethnic groups; Health inequities; Influenza; Pandemic; Social class.

Publication types

Review