Methods Inf Med 2004; 43(05): 486-492
DOI: 10.1055/s-0038-1633904
Original Article
Schattauer GmbH

Influenza-associated Excess Mortality from Monthly Total Mortality Data for Germany from 1947 to 2000

H. Uphoff
1   Centre for Health Protection, State of Hesse, Germany
,
N. I. Stilianakis
2   Joint Research Centre, European Commission, Ispra (Va), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2018 (online)

Summary

Objectives: Death attributable to influenza is noted under various causes in the mortality statistics. Therefore, excess of total mortality is frequently used for the estimation of the entire impact of influenza on mortality. Various models for the estimation of the expected mortality are in use but are rather complex which hampers their routine use. A simple and hence transparent model was developed and applied to the total mortality in Germany from 1947 to 2000.

Methods: The method is based on the pattern of the distribution of the mortality over the months. Additional trends over the time could be included with simple factors. In this manner the model was applicable over the total observation period.

Results: The fit for the months where influenza was not epidemic was good and comparable to other models (R2 = 0.91). The estimated excess mortality is plausible and congruent with estimates based on other models.

Conclusion: This method is applicable to long time series of any duration and obvious trends could be considered by simple factors in a readily identifiable and plausible way. Possible reductions in precision due to the consideration of a given monthly distribution pattern of the annual mortality seem tolerable with respect to the goodness of fit of the model. The estimation includes the pandemics of 1957/58 and 1968 to 1970.

 
  • References

  • 1 Simonsen L, Clark MJ, Williamson GD, Stroup DF, Arden NH, Schonberger LB. The Impact of Influenza Epidemics on Mortality: Introducing a Severity Index. Am J Public Health 1997; 87: 1944-50.
  • 2 Simonsen L, Schonberger LB, Stroup DF, Arden NH, Cox NJ. The impact of influenza on mortality in the USA. Options for the control of influenza III, Elsevier. 1996: 26-33.
  • 3 Haberland J, Baier WK, Bergmann KE. Der Einfluß der Grippeepidemien auf die Sterblichkeit in der Bundesrepublik Deutschland. Tätigkeitsbericht 1995 des Robert-Koch-Instituts, bga- Schriften. MMV, Medizin-Verlag München 1996; 163: 164
  • 4 Eggers M, Jennings S, Spuhler Th, Zimmermann HP, Paccaud F, Somaini B. Sterblichkeit während Grippeepidemien in der Schweiz 1969-9.
  • 5 Sprenger MJW, Mulder PGH, Beyer WEP, van Strik R, Masurel N. Impact of influenza on mortality in relation to age and underlying disease, 1967-1989. Int J Epidemiol 1993; 22: 334-40.
  • 6 Eisenmeier M. Exzessmortalität durch Influenza – ein methodischer Vergleich. Dissertation, Universität Tübingen. 1985
  • 7 Housworth J, Langmuir AD. Excess mortality from epidemic Influenza, 1957-1966. Am J Epidemiol 1974; 100: 40-8.
  • 8 Sprenger MJW, Mulder PGH, Beyer WEP, Masurel N. Influenza: Relation of mortality to morbidity parameters. Netherlands 1970-1989. Int J Epidemiol 1991; 20: 1118-24.
  • 9 Casper W, Wiesner G, Bergmann KE. Mortalität und Todesursachen in Deutschland. Bundesgesundheitsblatt. 1993; 317-33.
  • 10 Choi K, Thacker S. An evaluation of influenza mortality surveillance, 1962–1997. Am J Epidemiol 1981; 113: 215-26.
  • 11 Donald GC, Keating WR. Excess winter mortality or cold stress? Observational study. BMJ 2002; 324: 89-90.
  • 12 Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LG, Fukuda K. Mortality associated with Influenza and Respiratory Syncytial Virus in the United States. JAMA 2003; 289: 179-86.
  • 13 Nicholson KG. Impact of Influenza and RSV on mortality in England and Wales from January 1975 to December 1990. Epidemiol Infect 1996; 116: 51-63.
  • 14 Crombie DL, Fleming DM, Cross KW, Lancashire RJ. Concurrence of monthly variation of mortality related to underlying cause in Europe. J Epidemiol Community Health 1995; 49: 373-8.
  • 15 Spix C, Heinrich J, Dockery D, Schwartz J, Völksch G, Schwinkowski K, Cöllen C, Wichmann HE. Mortalität und Luftbelastung in Erfurt 1980 –1989. Informatik, Biometrie und Epidemiologie in der Medizin und Biologie 1994; 25: 48-57.
  • 16 Höpken W, Willers H. Epidemiologie der Influenza. Internist 1985; 26: 83-8.
  • 17 Statistisches Bundesamt: Allgemeine Sterbetafel 1970/72. Wirtschaft und Statistik 1974; 7: 465 ff
  • 18 Statistisches Bundesamt: Allgemeine Sterbetafel 1986/88. Wirtschaft und Statistik 1991; 6: 371 ff
  • 19 Jahresberichte des Staatlichen Medizinaluntersuchungsamtes in Hannover von 1977 bis 1992
  • 20 Glathe H, Rasch G. Influenzaüberwachung in der ehemaligen DDR im Zeitraum 1969-1990. Ergebnisse und Schlussfolgerungen. Bundesgesundheitsblatt 1992; 10: 500-6.ern. Bundesgesundheitsblatt 1992; 8: 411-2.
  • 21 Glathe H, Rasch G, Lange W, Lesnau A. Die Influenzasaison 1991/92 in den neuen Bundesländern. Bundesgesundheitsblatt 1992; 8: 500-6.
  • 22 Arbeitsgemeinschaft Influenza. Abschlussberichte der Influenzasaisons von 1993 bis 2000. Marburg/Berlin 1993 bis 2001
  • 23 Uphoff H, Szecsenyi J. Influenza-Monitoring mit dem bundesweiten Sentinel-System der Arbeitsgemeinschaft Influenza (AGI). Infektionsepidemiol Frschg 1996; 1: 6-11.
  • 24 Nicholson KG. Textbook of Influenza. Blackwell science. 1998
  • 25 Reichert AT, Sugaya N, Fedson SD, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating school children against inflIuenza. N Engl J Med 2001; 344: 889 ff