title: Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza-related hospitalizations in the United States.
abstract: BACKGROUND
  Findings from studies examining the association between obesity and acute respiratory infection are inconsistent. Few studies have assessed the relationship between obesity-related behavioral factors, such as diet and exercise, and risk of acute respiratory infection.
  
  
  OBJECTIVE
  To determine whether community prevalence of obesity, low fruit/vegetable consumption, and physical inactivity are associated with influenza-related hospitalization rates.
  
  
  METHODS
  Using data from 274 US counties, from 2002 to 2008, we regressed county influenza-related hospitalization rates on county prevalence of obesity (BMI ≥ 30), low fruit/vegetable consumption (<5 servings/day), and physical inactivity (<30 minutes/month recreational exercise), while adjusting for community-level confounders such as insurance coverage and the number of primary care physicians per 100,000 population.
  
  
  RESULTS
  A 5% increase in obesity prevalence was associated with a 12% increase in influenza-related hospitalization rates [adjusted rate ratio (ARR) 1.12, 95% confidence interval (CI) 1.07, 1.17]. Similarly, a 5% increase in the prevalence of low fruit/vegetable consumption and physical inactivity was associated with an increase of 12% (ARR 1.12, 95% CI 1.08, 1.17) and 11% (ARR 1.11, 95% CI 1.07, 1.16), respectively. When all three variables were included in the same model, a 5% increase in prevalence of obesity, low fruit/vegetable consumption, and physical inactivity was associated with 6%, 8%, and 7% increases in influenza-related hospitalization rates, respectively.
  
  
  CONCLUSIONS
  Communities with a greater prevalence of obesity were more likely to have high influenza-related hospitalization rates. Similarly, less physically active populations, with lower fruit/vegetable consumption, tended to have higher influenza-related hospitalization rates, even after accounting for obesity.
authors.affiliation: Children's Hospital Informatics Program, Children's Hospital Boston, Boston, MA, USA. katia.charland@mcgill.ca
authors.forename: Katia M
authors.initials: KM
authors.lastname: Charland
authors.forename: David L
authors.initials: DL
authors.lastname: Buckeridge
authors.forename: Anne G
authors.initials: AG
authors.lastname: Hoen
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Anne
authors.initials: A
authors.lastname: Elixhauser
authors.forename: Forrest
authors.initials: F
authors.lastname: Melton
authors.forename: John S
authors.initials: JS
authors.lastname: Brownstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005638:Fruit / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014675:Vegetables / Q000378:metabolism; D055815:Young Adult
keywords: Diet; exercise; influenza; influenza-like illness; obesity