Influenza as a trigger for cardiovascular disease: An investigation of serotype, subtype and geographic location

• Published in: Environmental research 2017-07, Vol.156, p.688-696
• Main Authors: Pearce, D.C., McCaw, J.M., McVernon, J., Mathews, J.D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; AMI; Ecological; Female; Geography; Hospitalization - statistics & numerical data; Humans; Humidity; IHD; Influenza; Influenza A Virus, H1N1 Subtype; Influenza A Virus, H3N2 Subtype; Influenza B virus; Influenza, Human - complications; Influenza, Human - epidemiology; Male; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Pneumonia; Queensland - epidemiology; Serogroup; Spatial
• ISSN: 0013-9351; 1096-0953
• DOI: 10.1016/j.envres.2017.04.024

Seasonal peaks of influenza and cardiovascular disease tend to coincide. Many excess deaths may be triggered by influenza, and the severity of this effect may vary with the virulence of the circulating influenza strain and host susceptibility. We aimed to explore the association between hospital admissions for influenza and/or pneumonia (IP) and acute myocardial infarction (AMI) or ischaemic heart disease (IHD) in Queensland, Australia, taking into account temporal and spatial variation of influenza virus type and subtype in 2007, 2008 and 2009. This ecological study at Statistical Subdivision level (SSD, n=38) used linked patient-level data. For each study year, Standardized Morbidity Ratios (SMRs) were calculated for hospital admissions with diagnoses of IP, AMI and IHD. We investigated the associations between IP and AMI or IHD using spatial autoregressive modelling, adjusting for socio-demographic factors. Spatial autocorrelation was detected in SMRs, possibly reflecting underlying social and behavioural risk factors, but consistent with infectious disease spread. SMRs for IP were consistently predictive of SMRs for AMI and IHD when adjusted for socioeconomic status, population density and per cent Indigenous population (coefficient: 0.707, 95% confidence interval (CI): 0.318 – 1.096; 0.553, 0.222 – 0.884; 0.598, 0.307 – 0.888 and 1.017, 0.711 – 1.323; 0.650, 0.342 – 0.958; 1.031, 0.827 – 1.236) in 2007, 2008 and 2009, respectively. This ecological study provides further evidence that severe respiratory infections may trigger the onset of cardiovascular events, implicating the influenza virus as a contributing factor. •Severe respiratory infections may trigger AMI and IHD.•Irrespective of type and subtype, the influenza virus may trigger the onset of cardiovascular disease.•Peak influenza circulation in 2009 occurred during winter irrespective of climatic zone.•Associations were detectable using an ecological study design.