title: Adiposity and influenza-associated respiratory mortality: a cohort study.
abstract: BACKGROUND
  Obesity was first noted as a risk factor for severe illness associated with pandemic H1N1 infection in 2009, but the relationship between obesity and seasonal influenza remains unclear.
  
  
  METHODS
  We used data from a population-based cohort comprising 66 820 older (≥65 years) participants with a follow-up period from 1998 to 2012. The impact of influenza activity on respiratory mortality rates was estimated using a Cox proportional hazards model adjusted for comorbidities, meteorological factors, and other co-circulating respiratory viruses. We also tested whether the association of influenza with respiratory mortality varied with obesity and/or health status. As a control outcome, we similarly assessed the association of influenza with deaths from external causes, because these deaths should be unrelated to influenza.
  
  
  RESULTS
  Seasonal influenza activity was associated with higher respiratory mortality (hazard ratio [HR], 1.13 for influenza activity in the influenza season vs noninfluenza season; 95% confidence interval [CI], 1.05-1.22). The effect of seasonal influenza was 19% greater in obese individuals than normal-weight individuals (HR, 1.19; 95% CI, 1.01-1.42). The marginally significant and greater effect modification of obesity status on the association between seasonal influenza and respiratory mortality was also observed among older people in good health (HR, 1.35; 95% CI, .97-1.87). No such relations were observed for death from external causes.
  
  
  CONCLUSIONS
  Obesity aggravates the effect of seasonal influenza on respiratory mortality. Priority for influenza vaccine should be considered for obese older people to decrease the burden of influenza.
authors: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong.
authors: Ying
authors: Y
authors: Zhou
authors: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong.
authors: Benjamin J
authors: BJ
authors: Cowling
authors: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong.
authors: Peng
authors: P
authors: Wu
authors: Department of Health, Hong Kong Government, Hong Kong Special Administrative Region, China.
authors: Wai Man
authors: WM
authors: Chan
authors: Department of Health, Hong Kong Government, Hong Kong Special Administrative Region, China.
authors: Siu Yin
authors: SY
authors: Lee
authors: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong.
authors: Eric H Y
authors: EH
authors: Lau
authors: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong School of Public Health at Hunter College, City University of New York, New York.
authors: C Mary
authors: CM
authors: Schooling
mesh_terms: D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000401:mortality*; D008297:Male; D016019:Survival Analysis
keywords: influenza; obesity; respiratory mortality