Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Danya Keene

Second Advisor

Gina Lovasi


INTRODUCTION: The literature has focused primarily on rhinoviruses as the major determinant of asthma exacerbations. The association between other respiratory viruses such as influenza and asthma exacerbations is not well characterized and further understanding can better inform prevention strategies to reduce influenza-related asthma.

OBJECTIVES: The primary objective of this study is to determine whether asthma hospitalizations of children and adults in the five boroughs of New York City is correlated with influenza hospitalizations temporally and spatially and whether these correlations differ by county or age.

METHODS: A times series regression analysis was performed using influenza hospitalizations as the explanatory series and and asthma hospitalizations as the outcome series. A cross correlation function was computed to determine the temporal correlations between the two time series. A measure similar to traditional attributable risks was calculated across age groups and boroughs to assess differences in influenza-related asthma hospitalizations. Additionally, times series analysis was stratified by age and boroughs to examine the significance of influenza and asthma correlations across strata.

RESULTS: A seasonal ARIMA (1,0,0)x(0,1,1)12 model was the final model for our data and yielded a significant positive correlation between asthma and influenza hospitalizations. After stratification by age, individuals 18 and older had significant correlations between influenza and asthma whereas there was no significant temporal correlation found in children 17 years or younger. Attributable risk percentages for adults (18-44, 45-64, 65+) increased with increasing age (2.9%, 3.4%, 4%, respectively). Positive significant correlations between asthma and influenza were found in the Bronx, Brooklyn, and Manhattan. Attributable risk percentages by borough identified the Bronx and Manhattan as the highest risk areas (2.6% and 2.5%).

CONCLUSION: Significant positive correlations between influenza and asthma hospitalizations were identified in this study. Influenza prevention strategies should emphasize older age groups. Environmental pollutants may interact with influenza to exacerbate asthma. Further research needs to be performed to understand the nature of interaction between environmental pollutants and respiratory viruses in effecting asthma and other respiratory-related outcomes.


This is an Open Access Thesis.