title: Monitoring mortality as an indicator of influenza in Catalonia, Spain.
abstract: OBJECTIVE
  This study aimed to investigate the behaviour of two indicators of influenza activity in the area of Barcelona and to evaluate the usefulness of modelling them to improve the detection of influenza epidemics.
  
  
  METHODS
  Descriptive time series study using the number of deaths due to all causes registered by funeral services and reported cases of influenza-like illness. The study concentrated on five influenza seasons, from week 45 of 1988 to week 44 of 1993. The weekly number of deaths and cases of influenza-like illness registered were processed using identification of a time series ARIMA model.
  
  
  METHODS
  Six large towns in the Barcelona province which have more than 60,000 inhabitants and funeral services in all of them.
  
  
  RESULTS
  For mortality, the proposed model was an autoregressive one of order 2 (ARIMA (2,0,0)) and for morbidity it was one of order 3 (ARIMA (3,0,0)). Finally, the two time series were analysed together to facilitate the detection of possible implications between them. The joint study of the two series shows that the mortality series can be modelled separately from the reported morbidity series, but the morbidity series is influenced as much by the number of previous cases of influenza reported as by the previous mortality registered.
  
  
  CONCLUSIONS
  The model based on general mortality is useful for detecting epidemic activity of influenza. However, because there is not an absolute gold standard that allows definition of the beginning of the epidemic, the final decision of when it is considered an epidemic and control measures recommended should be taken after evaluating all the indicators included in the influenza surveillance programme.
authors.affiliation: Department of Public Health and Health Regulations, Universitat de Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Domínguez
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Martínez
authors.forename: A
authors.initials: A
authors.lastname: Orcau
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D007251:Influenza, Human / Q000401:mortality*; D015233:Models, Statistical; D009017:Morbidity; D011159:Population Surveillance; D013030:Spain / Q000453:epidemiology