Public Health Reports has published a study co-authored by Rhode Island Hospital Medical Director of Epidemiology and Infection Control and Brown University Professor of Medicine Leonard A. Mermel, D.O., Sc.M., along with Kori Otero, M.P.H., a recent graduate of The School of Public Health at Brown University. 

The study, “Health Disparities Among People Infected with Influenza,” assessed Rhode Islanders with documented influenza during four respiratory virus seasons (Fall 2013 through Spring 2018) in Rhode Island to determine if health disparities were associated with risk of getting influenza, and if such disparities impacted the likelihood of severe disease manifested by a need for hospitalization. To address this issue, the authors measured median household income and educational level of influenza-infected patients.

Among the findings, there was a significantly greater number of confirmed influenza cases per 100,000 person-years  in populations with low versus high median household income. Greater numbers were also documented in populations with low versus high educational attainment. Further, the risk of a severe influenza infection was significantly greater in the population with the lowest educational attainment. However, an unexpected finding was that the risk of severe influenza was also associated with a higher median household income. 

Dr. Mermel notes that, “Our hypothesis was that we would find health disparities related to risk of influenza. This may be due to a lower access to primary care, less time available to receive influenza vaccination, and crowding living conditions.”  

“This finding may help to focus public health interventions in Rhode Island and elsewhere,” said Otero.

Lifespan’s own Community Health Institute (LCHI) serves as a “community immunizer” in an effort to overcome possible issues of access to flu vaccine, targeting adults who are medically fragile, uninsured, without a medical home, isolated or without transportation. In the 2019-20 flu season, its clinics provided immunizations to 844 adults, with numbers climbing each year since 2015. Clinics are currently being scheduled for Fall 2020, and community and faith-based organizations are invited to partner with the LCHI to host a flu clinic by calling 401-444-8063 or emailing  

The unexpected finding of increased hospitalization associated with higher household income may reflect a greater proportion of older adults in the higher socioeconomic groups, says Dr. Mermel, as well a possible intrinsic bias leading to a greater likelihood of hospitalization among people with higher socioeconomic status than among people with lower socioeconomic status. 

Says Mermel, “This study presaged some of the events occurring today with COVID-19, as health disparities remain a top-of-mind issue in addressing the needs of all Americans.”

Christina Spaight O'Reilly

Senior Public Relations Officer
Rhode Island Hospital