title: Risk factors for hospitalization and severe outcomes of 2009 pandemic H1N1 influenza in Quebec, Canada.
abstract: OBJECTIVE
  This case-control study was carried out to estimate risk factors associated with hospitalizations and severe outcomes [intensive care unit (ICU) admission or death] among patients with illness because of laboratory-confirmed 2009 pandemic A/H1N1 virus (pH1N1) during the first wave of pH1N1 activity in the province of Quebec, Canada.
  
  
  METHODS
  We collected epidemiologic information by phone using a standardized questionnaire from patients with laboratory-confirmed pH1N1 illness during the first spring/summer pandemic wave in Quebec, Canada. Risk factors associated with hospitalization were assessed by comparing hospitalized to community cases and for ICU admission or death through comparison with hospitalized cases.
  
  
  RESULTS
  Cases (321 hospitalized patients including 47 ICU admissions and 15 deaths) were compared to controls (395 non-hospitalized patients) by using multivariable logistic regression adjusted for gender, age, education, being a health care worker, smoking, seasonal influenza vaccination, delay to consultation, antiviral use before admission, pregnancy, underlying medical conditions, and obesity. Age <5 years, underlying medical conditions (neuromuscular, cardiac, pulmonary, and renal conditions, diabetes, asthma, and other), and delayed consultation were associated with hospitalization. The strongest association with hospitalization was observed for neuromuscular disorders. Antiviral medication before hospital admission protected against severe disease. Association of obesity with hospitalization was not significant after adjustment in multivariable analysis. Among hospitalized patients, age ≥60 years and immune suppression were associated with death.
  
  
  CONCLUSIONS
  Previously identified risk factors for seasonal influenza were also associated with increased risk of severe pH1N1 outcomes. The independent role of obesity needs to be further defined.
authors.affiliation: Quebec National Institute of Public Health, Quebec City, QC, Canada. rodica.gilca@ssss.gouv.qc.ca
authors.forename: Rodica
authors.initials: R
authors.lastname: Gilca
authors.forename: Gaston
authors.initials: G
authors.lastname: De Serres
authors.forename: Nicole
authors.initials: N
authors.lastname: Boulianne
authors.forename: Najwa
authors.initials: N
authors.lastname: Ouhoummane
authors.forename: Jesse
authors.initials: J
authors.lastname: Papenburg
authors.forename: Monique
authors.initials: M
authors.lastname: Douville-Fradet
authors.forename: Élise
authors.initials: É
authors.lastname: Fortin
authors.forename: Marc
authors.initials: M
authors.lastname: Dionne
authors.forename: Guy
authors.initials: G
authors.lastname: Boivin
authors.forename: Danuta M
authors.initials: DM
authors.lastname: Skowronski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology* / Q000821:virology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D058873:Pandemics; D011247:Pregnancy; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult