title: Seasonal Influenza Infections and Cardiovascular Disease Mortality.
abstract: Cardiovascular deaths and influenza epidemics peak during winter in temperate regions.
  
  
  
  To quantify the temporal association between population increases in seasonal influenza infections and mortality due to cardiovascular causes and to test if influenza incidence indicators are predictive of cardiovascular mortality during the influenza season.
  
  
  
  Time-series analysis of vital statistics records and emergency department visits in New York City, among cardiovascular deaths that occurred during influenza seasons between January 1, 2006, and December 31, 2012. The 2009 novel influenza A(H1N1) pandemic period was excluded from temporal analyses.
  
  
  
  Emergency department visits for influenza-like illness, grouped by age (≥0 years and ≥65 years) and scaled by laboratory surveillance data for viral types and subtypes, in the previous 28 days.
  
  
  
  Mortality due to cardiovascular disease, ischemic heart disease, and myocardial infarction.
  
  
  
  Among adults 65 years and older, who accounted for 83.0% (73 363 deaths) of nonpandemic cardiovascular mortality during influenza seasons, seasonal average influenza incidence was correlated year to year with excess cardiovascular mortality (Pearson correlation coefficients ≥0.75, P ≤ .05 for 4 different influenza indicators). In daily time-series analyses using 4 different influenza metrics, interquartile range increases in influenza incidence during the previous 21 days were associated with an increase between 2.3% (95% CI, 0.7%-3.9%) and 6.3% (95% CI, 3.7%-8.9%) for cardiovascular disease mortality and between 2.4% (95% CI, 1.1%-3.6%) and 6.9% (95% CI, 4.0%-9.9%) for ischemic heart disease mortality among adults 65 years and older. The associations were most acute and strongest for myocardial infarction mortality, with each interquartile range increase in influenza incidence during the previous 14 days associated with mortality increases between 5.8% (95% CI, 2.5%-9.1%) and 13.1% (95% CI, 5.3%-20.9%). Out-of-sample prediction of cardiovascular mortality among adults 65 years and older during the 2009-2010 influenza season yielded average estimates with 94.0% accuracy using 4 different influenza metrics.
  
  
  
  Emergency department visits for influenza-like illness were associated with and predictive of cardiovascular disease mortality. Retrospective estimation of influenza-attributable cardiovascular mortality burden combined with accurate and reliable influenza forecasts could predict the timing and burden of seasonal increases in cardiovascular mortality.
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Nguyen
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Wan
authors.initials: W
authors.lastname: Yang
authors.affiliation: Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ito
authors.affiliation: Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Matte
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shaman
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Kinney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D009519:New York City / Q000453:epidemiology; D012621:Seasons