Risk Factors Associated With Severe Acute Respiratory Infections Cases

117 Pages·2017·3.42 MB·English

Walden University
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Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2016
Risk Factors Associated With Severe Acute
Respiratory Infections Cases
Ryan Gatdula Ortiguerra
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Ryan Ortiguerra

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Aimee Ferraro, Committee Chairperson, Public Health Faculty
Dr. Namgyal Kyulo, Committee Member, Public Health Faculty
Dr. John Oswald, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
Risk Factors Associated With Severe Acute Respiratory Infections Cases
by
Ryan Ortiguerra

Bachelor of Science, San Diego State University, 2004

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
November, 2015
Abstract

The close proximity of the United States to the Mexican border poses a concern for
communicable diseases because of the high flow of population movement. The purpose
of this retrospective, quantitative study was to identify risks associated with respiratory
diseases using an analysis of archived data from the Severe Acute Respiratory Illness
(SARI) surveillance program. Based on the epidemiologic triangle theory, demographic
and etiologic factors were analyzed to examine any associations with SARI in this
population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336
(42.1%) testing positive for respiratory pathogens. Chi square analysis determined that
age (X2 (4, N = 786) = 255.361, p < 0.001), clinic location (X2 (3, N = 780) = 290.841, p
< 0.001), and race/ethnicity (X2 (4, N = 762) = 1456.701, p < 0.001) showed significant
associations with SARI in the population. The logistic regression model showed that the
youngest age group (0-4) had the highest risk of developing SARI compared to other age
groups (5-24 OR = 0.521, 95% CI [0.311-0.871]; 25-49 OR = 0.377, 95% CI [0.224-
0.636]; 50-64 OR = 0.211, 95% CI [0.118-0.376]; >65 OR = 0.225, 95% CI [0.143-0.356].
African Americans were also at higher risk of developing SARI compared to Hispanic
Americans (OR = 3.997, 95% CI [1.272-12.558]. This study promotes positive social
change by informing efforts to increase vaccination and health literacy, improve the
accessibility and availability of preventive health care in low socioeconomic communities,
and promote healthy lifestyles among at-risk groups. These steps will improve the overall
health of the communities along the U.S.-Mexico border region.
Risk Factors Associated With Severe Acute Respiratory Infections Cases
by
Ryan Ortiguerra

Bachelor of Science, San Diego State University, 2004

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
November, 2015
Table of Contents

List of Tables ..................................................................................................................... iv
Chapter 1: Introduction to the Study ....................................................................................1
Background ....................................................................................................................1
Problem Statement .........................................................................................................6
Purpose of the Study ............................................................................................... 9
Research Question and Hypotheses .............................................................................10
Theoretical Foundation ......................................................................................... 10
Nature of the Study ......................................................................................................11
Definitions....................................................................................................................12
Scope and Delimitations ..............................................................................................13
Limitations ...................................................................................................................14
Significance..................................................................................................................17
Summary ......................................................................................................................18
Chapter 2: Review of Literature ........................................................................................20
Introduction ..................................................................................................................20
Literature Search Strategy..................................................................................... 21
Theoretical Foundation ......................................................................................... 22
Risk Factors for SARI ..................................................................................................27
Age Group ............................................................................................................. 27
Geographic Location ............................................................................................. 30
Immunization ........................................................................................................ 32
i
Gender ................................................................................................................... 35
Comorbidities ........................................................................................................ 36
Review of Literature Related to Methods ....................................................................39
Summary ......................................................................................................................40
Chapter 3: Research Design and Methods .........................................................................42
Introduction ..................................................................................................................42
Research Design and Rationale ...................................................................................42
Methodology ................................................................................................................44
Population and Sampling ...................................................................................... 44
Procedures for Recruitment, Participation, and Data Collection .......................... 45
Operationalization of Variables ...................................................................................48
Data Analysis Plan ................................................................................................ 51
Threats to Validity .......................................................................................................52
Ethical Procedures .......................................................................................................53
Summary ......................................................................................................................56
Chapter 4: Data Summary .................................................................................................57
Introduction ..................................................................................................................57
Results ..........................................................................................................................59
Descriptive Summary of Study Population........................................................... 59
Analysis of SARI Cases Overall ..................................................................................62
Summary ......................................................................................................................69
Chapter 5: Interpretation and Conclusion ..........................................................................71
ii
Introduction ..................................................................................................................71
Interpretation of the Findings.......................................................................................72
Limitations of the Study...............................................................................................79
Recommendations ........................................................................................................81
Implications..................................................................................................................82
Conclusion ...................................................................................................................87
Appendix A: Data Use Agreement Form.........................................................................103
Appendix B: Letter of Cooperation from Research Partner ............................................105

iii
List of Tables
Table 1. Operationalization of Variables Collected During SARI Enrollment………….49
Table 2. Descriptive Summary of the Study Population by Variables
(N = 798)………………………………………………….…………………….60
Table 3. Chi-Square Analysis of the Study Population by Test Variables………………64
Table 4. The Odds Ratio of SARI Diseases Associated With Study
Population Belonging to Different Age Groups……………………………….69
Table 5. Summary of Statistical Tests Performed Outlining Independent
Variables and Their Significance..……………………………………………..70
Table 6. Demographic Data of the Population Surrounding the SARI Clinics………….75

iv
1

Chapter 1: Introduction to the Study
Background
One of the biggest concerns of the modern era is the effect of communicable
diseases on the global population and ensuring that proper surveillance is practiced in
order to keep communicable diseases at bay. Proper enhancement of respiratory disease
surveillance permits the assessment of multiple determining factors that affect disease
activity (Ortiz et al., 2009). These factors include the differences in effectiveness of
disease control measures, such as social distancing and vaccination between developed
and underdeveloped communities. Disease surveillance efforts must be sensitive to the
real number of cases through adequate surveillance techniques employed. Surveillance
can include accurate case definitions and effective surveillance protocols, especially in
certain regions of the United States such as the U.S.-Mexico border, where there is an
increased population movement and incidence of communicable diseases.
There was a significantly increased incidence of vaccine-preventable diseases in
major U.S. counties within 100 kilometers from the border between 1990 and 1998
(Weinberg et al., 2003). There are a number of factors that contribute to the increase in
incidence of acute respiratory illness (ARI) seen along this region of the United States,
such as poor health care facilities and services that would provide the necessary
preventative and medical care for the population living along the surrounding
communities. In addition, some of the lowest socioeconomic communities lie along the
U.S.-Mexico border region, which spans over 2,000 miles from the southern tip of Texas
to the Pacific Coast in California (Weinberg et al., 2003). The unique composition of the