{"doi":"10.2196/preprints.82879","title":"County-Level Influenza-Attributable Emergency Department Visits and Their Spatial Correlates in the United States: Cross-Sectional Observational Study (Preprint)","abstract":"<sec> <title>BACKGROUND</title> The burden of seasonal influenza on emergency department (ED) visits is poorly quantified due to case ascertainment and data availability challenges. This study estimates county-level respiratory ED visits attributable to influenza using time-series models and examines spatial heterogeneity in county-level burden in 3 states. </sec> <sec> <title>OBJECTIVE</title> This study aimed to estimate the county-level respiratory ED visits attributable to influenza using time-series models and examine spatial heterogeneity in county-level burden in 3 states. </sec> <sec> <title>METHODS</title> We used daily hospital discharge records to measure community-level influenza activity in California (2005-2018), Georgia (2010-2018), and New York (2005-2018). County-level respiratory ED visit rates attributable to influenza were estimated by quasi-Poisson time-series models, adjusting for temporal trends and environmental factors. Bayesian spatial models were used to assess associations with county-level socioeconomic status, environmental exposures, and chronic health condition prevalence. </sec> <sec> <title>RESULTS</title> Influenza-attributable respiratory ED visit rates per 100,000 population were 226 (95% CI 206-246) in New York, 232 (95% CI 206-259) in California, and 547 (95% CI 506-589) in Georgia. A 10% increase in county-level poverty and uninsured rates was associated with higher influenza burden, increasing influenza-attributable respiratory ED visit rates by 160 (95% credible interval [CrI] 127-196) and 217 (95% CrI 168-265), respectively. Long-term PM&lt;sub&gt;2.5&lt;/sub&gt; (fine particulate matter ≤2.5 µm), humidity, and temperature also exhibited positive associations. Chronic conditions also increased ED visit rates by 1476/100,000 (95% CrI 1167-1778), 588/100,000 (95% CrI 400-747), and 488/100,000 (95% CrI 402-574) per 10% increase in stroke, chronic obstructive pulmonary disease, and diabetes prevalence, respectively. These associations weakened after adjusting for socioeconomic status. </sec> <sec> <title>CONCLUSIONS</title> Influenza-attributable respiratory ED visit rates exhibit significant spatial heterogeneity that is associated with county-level socioeconomic factors, environmental exposures, and chronic disease prevalence. </sec>","journal":null,"year":2025,"id":573533,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9404,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":106837,"name":"Joshua L. Warren","orcid":"0000-0002-6274-6970","position":1,"is_corresponding":false},{"id":1480272,"name":"Shuqi Lin","orcid":"0009-0009-4016-0029","position":2,"is_corresponding":false},{"id":239777,"name":"Stefanie Ebelt","orcid":"0000-0003-4713-2337","position":3,"is_corresponding":false},{"id":239779,"name":"Howard H. Chang","orcid":"0000-0002-6316-1640","position":4,"is_corresponding":false},{"id":1480271,"name":"Xucheng Huang","orcid":"0009-0001-1918-1548","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:57:32.445190Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}