title: Influenza and seasonal patterns of hospital use by older adults in long-term care and community settings in Ontario, Canada.
abstract: OBJECTIVE
  We compared seasonal influenza hospital use among older adults in long-term care (LTC) and community settings.
  
  
  METHODS
  We used provincial administrative data from Ontario to identify all emergency department (ED) visits and hospital admissions for pneumonia and influenza among adults older than 65 years between 2002 and 2008. We used sentinel laboratory reports to define influenza and summer seasons and estimated mean annual event rates and influenza-associated rates.
  
  
  RESULTS
  Mean annual pneumonia and influenza ED visit rates were higher in LTC than the community (rate ratio [RR] for influenza season = 3.9; 95% confidence interval [CI] = 3.8, 4.0; for summer = 4.9; 95% CI = 4.8, 5.1) but this was attenuated in influenza-associated rates (RR = 2.4; 95% CI = 2.1, 2.8). The proportion of pneumonia and influenza ED visits attributable to seasonal influenza was 17% (15%-20%) in LTC and 28% (27%-29%) in the community. Results for hospital admissions were comparable.
  
  
  CONCLUSIONS
  We found high rates of hospital use from LTC but evidence of lower impact of circulating influenza in the community. This differential impact of circulating influenza between the 2 environments may result from different influenza control policies.
authors: Andrea Gruneir and Paula A. Rochon are with the Women's College Research Institute, Women's College Hospital, Toronto, ON. Jeff C. Kwong, Michael A. Campitelli, and Alice Newman are with the Institute for Clinical Evaluative Sciences, Toronto. Geoffrey M. Anderson is with the Institute of Health Policy, Management, and Evaluation, University of Toronto. Vincent Mor is with the Department of Health Services, Policy and Practice, Brown University, Providence, RI.
authors: Andrea
authors: A
authors: Gruneir
authors: Jeff C
authors: JC
authors: Kwong
authors: Michael A
authors: MA
authors: Campitelli
authors: Alice
authors: A
authors: Newman
authors: Geoffrey M
authors: GM
authors: Anderson
authors: Paula A
authors: PA
authors: Rochon
authors: Vincent
authors: V
authors: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012621:Seasons