Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

James Hadler


Influenza is a significant public health problem in the United States and around the world, causing considerable morbidity and mortality annually. Drug use is also a significant issue that is associated with numerous health complications and conditions. However, the relationship between severe influenza outcomes and drug use is not well understood. The objectives of this investigation are to compare the prevalence of demographic and behavioral factors associated with severe influenza outcomes between persons who use drugs (PWUDs) and non-PWUDs hospitalized with influenza and, by controlling for those factors we find are significant, determine if there is an association between severe influenza outcomes and drug use.

This analysis uses national FluSurv-NET data from the 2016-2017, 2017-2018, and 2018-2019 influenza seasons on persons who were admitted to a hospital and had a laboratory-confirmed positive test for influenza. Descriptive statistics, chi-square tests of independence, age-adjusted and crude odds/risk ratios, 95% confidence intervals, and logistic regression models were used to evaluate differences in demographics, risk and behavioral factors, specific drug use, and severe influenza outcomes among PWUD and non-PWUD cases.

There were 51,265 lab-confirmed influenza hospitalizations, among whom were 1,766 PWUDs. PWUDs were younger than non-PWUDs and more likely to be male, Black or Latinx, smoke tobacco, abuse alcohol, and have chronic conditions like asthma, chronic liver disease, chronic lung disease, or immunosuppressive conditions. PWUDs were more likely to experience ICU admission and mechanical ventilation but were not more likely to die during their hospitalization. PWUDs were less likely to receive the seasonal influenza vaccine, a protective intervention that was associated with decreased risk of ICU admission and being mechanically ventilated. These results have great potential to inform interventions with this at-risk population.


This is an Open Access Thesis.

Open Access

This Article is Open Access