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Volume 17, Number 8—August 2011

Dispatch

Pandemic (H1N1) 2009–associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance

Christine H. LeesComments to Author , Catherine Avery, Ryan Asherin, Jean Rainbow, Richard Danila, Chad Smelser, Ann Schmitz, Stephen Ladd-Wilson, Kurt B. Nolte, Kayla Nagle, and Ruth Lynfield
Author affiliations: Author affiliations: Minnesota Department of Health, St. Paul, Minnesota, USA (C.H. Lees, J. Rainbow, R. Danila, K. Nagle, R. Lynfield); New Mexico Department of Health, Santa Fe, New Mexico, USA (C. Avery, C. Smelser); Oregon Public Health Department, Portland, Oregon, USA (R. Asherin, S. Ladd-Wilson); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Schmitz); University of New Mexico School of Medicine, Albuquerque, New Mexico, USA (K.B. Nolte)

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Table 2

Clinical description of patients whose deaths were associated with pandemic (H1N1) 2009, by surveillance program, Minnesota, New Mexico, and Oregon, April–December 2009*

Underlying conditions Hospital surveillance decedents, n = 160 UNEX/Med-X decedents, n = 34 p value†
>1 conditions 142 (89) 23 (68) 0.002
Asthma 24 (15) 3 (9) 0.43
Chronic lung disease 51 (32) 7 (21) 0.19
Cardiovascular disease 59 (37) 8 (24) 0.14
Chronic metabolic disease 55 (34) 9 (26) 0.37
Renal disease 17 (11) 1 (3) 0.21
Neuromuscular disorder 19 (12) 2 (6) 0.54
Cancer, past 12 months 10 (6) 0 (0) 0.21
Lymphoma/leukemia 9 (6) 0 (0) 0.36
Immunosuppressive conditions 30 (19) 2 (6) 0.08
Pregnancy
0
0

Obesity‡ 29 (18) 9 (27) 0.27
Morbidly obese‡ 23 (14) 4 (12) 1.0
Body mass index‡
  Median 29.2 31.8 0.95§
Mean
32.6
30.7

Clinical outcomes¶
Pneumonia 72 (78) 15 (58) 0.04
   Viral 12 (17) 6 (40)
   Bacterial# 8 (11) 2 (13)
   Both 8 (11) 1 (7)
   Unknown 44 (61) 6 (40)
Acute respiratory distress syndrome 34 (37) 4 (15) 0.06
Myocarditis 0 (0) 2 (8) 0.05

*Values are no. (%) except as indicated. UNEX, Centers for Disease Control and Prevention Emerging Infections Program Unexplained Deaths Program; Med-X, Medical Examiner Infectious Disease Death Surveillance Program.
†By χ2 or Fisher exact test.
‡Obese was defined as either documentation in the medical record of “obese” or a body mass index (BMI) >30 kg/m2 and <40 kg/m2. Morbidly obese was defined as either documentation in the medical record of “morbidly obese” or a BMI >40 kg/m2. If there was a discrepancy, BMI was used. BMI data were available for 80 case-patients and were calculated for adults by using National Institute of Health BMI calculation tables and for children 2–19 years of age by using the Centers for Disease Control and Prevention pediatric BMI calculation.
§By Wilcoxon Mann-Whitney test.
¶Data available from Minnesota and New Mexico only; n = 92 for hospital surveillance and n = 26 for UNEX/Med-X.
#Bacterial species included 4 Streptococcus pneumoniae, 4 methicillin-resistant Staphylococcus aureus, 3 methicillin-susceptible S. aureus, 2 group A Streptococcus spp., and 2 others. Some case-patients had >1 species identified.

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