Influenza-associated mortality in Yancheng, China, 2011-15.


The Yangtze river delta in eastern China, centered on Shanghai, is one of the most populated regions of the world with more than 100 million residents. We examined the impact of influenza on excess mortality in Yancheng, a prefecture-level city with 8.2 million population located 250 km north of Shanghai, during 2011-2015.

We obtained individual data on deaths by date, age, sex, and cause in Yancheng from the Chinese Centers for Disease Control and Prevention, and used these to derive weekly rates of mortality from respiratory causes, respiratory and cardiovascular causes combined, and all causes. We used data on influenza-like illnesses and laboratory detections of influenza to construct a proxy measure of the weekly incidence of influenza virus infections in the community. We used regression models to estimate the association of influenza activity with mortality and excess mortality by age, cause, and influenza type/subtype.

We estimated that an annual average of 4.59 (95% confidence interval: 3.94, 7.41) excess respiratory deaths per 100 000 persons were associated with influenza, which was 4.6% of all respiratory deaths in the years studied. Almost all influenza-associated excess deaths occurred in persons ≥65 years. Influenza A(H3N2) had the greatest impact on mortality and was associated with around 50% of the influenza-associated respiratory deaths in the 5 years studied.

Influenza has a substantial impact on respiratory mortality in Yancheng, mainly in older adults. Influenza vaccination has the potential to reduce disease burden, and cost-effectiveness analysis could be used to compare policy options.

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