Mortality Rates for Pneumonia and Influenza Vary by Geographical Area

A hospital corridor.
Facilities that treated more patients with classical Hodgkin lymphoma annually had lower overall mortality rates.
Researchers assessed whether there was geographic variation in racial disparity in influenza and pneumonia.

Non-Hispanic Black (NHB) patients had a higher mortality rate from influenza and pneumonia than non-Hispanic White (NHW) patients when compared by geographical region between 1999 and 2018, particularly in major metropolitan areas, according to an analysis published in CHEST.

Investigators analyzed data from the Centers for Disease Control and Prevention (CDC) database for multiple cause of death on NHB and NHW with an ICD-10 diagnosis of influenza and pneumonia between 1999 and 2018.

Investigators used age-adjusted mortality rates (AAMR) grouped by Health and Human Services (HHS) regions and race to assess geographic variation in racial disparity of influenza and pneumonia as an underlying cause of death (UCOD). Crude death rates by race were computed for 10-year age groups for ages 25 and older, and AAMR per 100,000 for ages 25-84 were computed using the 2000 United States standard population.

The UCOD crude death rate was significantly higher in NHB than NHW in each 10-year age group 25 years and older, with the greatest disparity at 45-54 years and least disparity at 75-84 years.

The AAMR for influenza and pneumonia was higher in NHB patients than NHW patients in 7 of 10 HHS regions for ages 25 to 84 between 1999 and 2018. The difference in AAMR was highest in New York and New Jersey (region 2), where the AAMR for NHB patients was 24.59 (95% CI, 24.12-25.06) vs 15.71 (95% CI, 15.56-15.86) for NHW patients. Similar results were seen in Arizona, California, Hawaii, and Nevada (region 9), where the AAMR for NHB was 23.24 (95% CI, 22.67-23.82) vs 16.06 (95% CI, 15.92-16.29) for NHW. AAMRs were similar between NHB and NHW in HHS regions 1, 8 and 10.

In HHS regions 2 and 9, the AAMR was significantly higher for NHB than NHW patients in medium to large central metropolitan areas, nearly equal in small metropolitan areas, and higher for NHW than NHB patients in nonmetropolitan areas.

“Multiple harmful biosocial conditions (poverty, homelessness, lack of health insurance) interact synergistically resulting in excess burden of disease in the NHB population,” investigators wrote, citing several supporting studies.

Investigators recommended improving chronic disease prevention and management, encouraging influenza and pneumonia vaccination, and enhancing access to quality healthcare in order to address the higher AAMR rates for NHB in HHS regions 2 and 9.


Donaldson SV, Thomas AN, Gillum RF, Mehari A. Geographic variation in racial disparities in mortality from influenza and pneumonia in the US in the pre-COVID-19 era. CHEST. Published online January 2, 2021. doi:10.1016/j.chest.2020.12.029