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We used the Merative Marketscan database (2001\u20132019) and time-series methods to identify age-specific categories of diseases that were temporally associated with patterns of influenza activity. Next, we estimated hypothetical reductions in the incidence and costs of these diseases if influenza incidence were reduced. Of 282 different disease categories evaluated, 23 (8.2%) were strongly associated with influenza (e.g., acute bronchitis, otitis media, myocardial infarctions, sinusitis, COPD) in at least one age group. For example, we estimated a 20% decrease in peak influenza incidence could decrease acute bronchitis cases by 6.5% and pneumonia cases by 5.3%, corresponding to a $1.6 billion reduction in healthcare costs. Excluding secondary diseases associated with influenza may lead to substantial underestimates of influenza\u2019s burden and costs.<\/jats:p>","DOI":"10.1017\/s0950268826101320","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:04:11Z","timestamp":1775444651000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Disease burden associated with influenza activity at the population level"],"prefix":"10.1017","volume":"154","author":[{"given":"Aaron C.","family":"Miller","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Iowa Roy J and Lucille A Carver College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Erik","family":"Boonstra","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Iowa College of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Cavanaugh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Iowa College of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantina","family":"Boikos","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/059g90c15","id-type":"ROR","asserted-by":"publisher"}],"name":"Pfizer Canada ULC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyan","family":"Hu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01xdqrp08","id-type":"ROR","asserted-by":"publisher"}],"name":"Pfizer Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McLaughlin","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01xdqrp08","id-type":"ROR","asserted-by":"publisher"}],"name":"Pfizer Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Weimken","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01xdqrp08","id-type":"ROR","asserted-by":"publisher"}],"name":"Pfizer Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verna","family":"Welch","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01xdqrp08","id-type":"ROR","asserted-by":"publisher"}],"name":"Pfizer Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0630-5898","authenticated-orcid":false,"given":"Philip M.","family":"Polgreen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Iowa Roy J and Lucille A Carver College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"S0950268826101320_r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.04.057"},{"key":"S0950268826101320_r15","doi-asserted-by":"publisher","DOI":"10.1086\/660859"},{"key":"S0950268826101320_r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.09.048"},{"key":"S0950268826101320_r29","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12963"},{"key":"S0950268826101320_r17","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781107049994"},{"key":"S0950268826101320_r6","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad244"},{"key":"S0950268826101320_r2","unstructured":"[2] Centers for Disease Control and Prevention Estimated Range of Annual Burden of Flu in the US from 2010-2025. https:\/\/www.cdc.gov\/flu-burden\/php\/about\/index.html (accessed 20 April 2026)."},{"key":"S0950268826101320_r37","doi-asserted-by":"publisher","DOI":"10.1086\/651095"},{"key":"S0950268826101320_r19","unstructured":"[19] Centers for Disease Control and Prevention. 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