Characterizing healthcare-seeking behavior of the general population with influenza-related symptoms in Hong Kong

Abstract

[Abstract topic: Advancing public health surveillance of severity] Characterizing healthcare-seeking behavior of the general population with influenza-related symptoms in Hong Kong Qiqi Zhang, Shuo Feng, Irene O.L. Wong, Benjamin J. Cowling, Eric H.Y. Lau School of Public Health, the University of Hong Kong [2734/2750 characters including space] Background Healthcare-seeking behavior can affect health outcomes of individual patients and understanding of disease burden and severity at the population level. Many previous studies examined healthcare-seeking behavior according to the diagnosed disease. However, for patients, it was the symptoms or discomfort rather than the diagnosed diseases which determine their healthcare seeking decisions. Our study described the likelihood and type of healthcare utilization, and time from symptom onset to consultation due to different influenza-related symptoms. We also identified factors associated with healthcare-seeking behavior. Method We conducted a 4-round longitudinal telephone survey, on multiple symptoms related to common infectious diseases in Hong Kong. We examined their healthcare-seeking behavior triggered by influenza-related symptoms (fever, cough, runny nose, sore throat, headache, chills, and fatigue) and by influenza-like illness (ILI) and acute respiratory infection (ARI). Post-stratification and multiple imputation were used to account for non-response and handle missing/right-censored healthcare-seeking behavior due to the short time interview between symptom onset and the interview. We further explored factors associated with healthcare-seeking behavior by using generalized estimating equation model. Results 91% and 64% of subjects having ILI and ARI, respectively sought medical consultation. Considering specific influenza-related symptoms, among the subjects with fever, 78% sought medical consultation due to the symptom. The proportions dropped to 47%, 32% and 14% for cough, chills and fatigue respectively. Among those who have sought medical consultation, 84% of them visited a doctor within 3 days of symptom onset (91% and 85% for those with ILI and ARI respectively). Subjects who sought medical consultation due to fever and chills tend have a shorter onset-to-consultation duration. Based on the multivariable GEE model, we found that people having fever (adjusted odds ratio aOR=5.4, 95% CI=3.4–8.8) were most likely to seek medical consultation, followed by cough and runny nose (aORs=1.6). There was no significant difference in healthcare seeking behavior during or out of the influenza season. Conclusion Fever was the strongest driver for subjects having influenza-related symptoms to seek healthcare services. Among those subjects who have sought consultation, the majority of them visited doctors within 3 days. The findings could inform estimation of influenza disease burden and confirm that fever and cough are crucial for ILI syndromic surveillance. The findings is applicable to the Hong Kong general population but generalizability to other places has to be further assessed.