{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:55:10Z","timestamp":1787165710900,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Seasonal influenza illness and acute respiratory infections can impose a substantial economic burden in low\u2010 and middle\u2010income countries (LMICs). We assessed the cost of influenza illness and acute respiratory infections across household income strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of data from a prior systematic review of costs of influenza and other respiratory illnesses in LMICs and contacted authors to obtain data on cost of illness (COI) for laboratory\u2010confirmed influenza\u2010like illness and acute respiratory infection. We calculated the COI by household income strata and calculated the out\u2010of\u2010pocket (OOP) cost as a proportion of household income.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 11 studies representing 11 LMICs. OOP expenses, as a proportion of annual household income, were highest among the lowest income quintile in 10 of 11 studies: in 4\/4 studies among the general population, in 6\/7 studies among children, 2\/2 studies among older adults, and in the sole study for adults with chronic medical conditions. COI was generally higher for hospitalizations compared with outpatient illnesses; median OOP costs for hospitalizations exceeded 10% of annual household income among the general population and children in Kenya, as well as for older adults and adults with chronic medical conditions in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings indicate that influenza and acute respiratory infections pose a considerable economic burden, particularly from hospitalizations, on the lowest income households in LMICs. Future evaluations could investigate specific drivers of COI in low\u2010income household and identify interventions that may address these, including exploring household coping mechanisms. Cost\u2010effectiveness analyses could incorporate health inequity analyses, in pursuit of health equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.70059","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T02:10:48Z","timestamp":1736475048000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Costs of Influenza Illness and Acute Respiratory Infections by Household Income Level: Catastrophic Health Expenditures and Implications for Health Equity"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8963-4613","authenticated-orcid":false,"given":"Natalie","family":"Wodniak","sequence":"first","affiliation":[{"name":"Influenza Division Centers for Disease Control and Prevention  Atlanta Georgia USA"},{"name":"Thailand Ministry of Public Health\u2010U.S. Centers for Disease Control and Prevention Collaboration  Nonthaburi Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-5628","authenticated-orcid":false,"given":"Radhika","family":"Gharpure","sequence":"additional","affiliation":[{"name":"Influenza Division Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luzhao","family":"Feng","sequence":"additional","affiliation":[{"name":"School of Population Medicine &amp; Public Health, Chinese Academy of Medical Sciences Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-286X","authenticated-orcid":false,"given":"Xiaozhan","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Fang","sequence":"additional","affiliation":[{"name":"China Center for Health Development Studies Peking University  Beijing China"},{"name":"Health Science Center \u2013 Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmei","family":"Tian","sequence":"additional","affiliation":[{"name":"Children's Hospital of Soochow University  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3160-809X","authenticated-orcid":false,"given":"Genming","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Salcedo\u2010Mej\u00eda","sequence":"additional","affiliation":[{"name":"ALZAK Foundation  Cartagena Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson\u00a0J.","family":"Alvis\u2010Zakzuk","sequence":"additional","affiliation":[{"name":"ALZAK Foundation  Cartagena Colombia"},{"name":"Department of Health Sciences Universidad de la Costa  Barranquilla Colombia"},{"name":"Post\u2010Graduation Program in Epidemiology, School of Public Health Univsersity of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Jara","sequence":"additional","affiliation":[{"name":"Pan American Health Organization  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimah","family":"Dawood","sequence":"additional","affiliation":[{"name":"Influenza 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