Listen up, city dwellers. 

By Korin Miller
September 24, 2019

Flu season has officially started in the U.S. and there are already reports of cases across the country. While technically everyone is at risk of developing the flu (yes, even with a flu shot), an interesting new study found that living in certain areas of a city can influence your flu risk.

The study, which was published on bioRxiv, a database for "preprints" of articles not yet published by a peer-reviewed journal, incorporated neighborhood differences into an epidemiological model and used census data for Guadalajara, Mexico. In a collaborative effort between Georgia State University, the National Institutes of Health, Scripps Institution of Oceanography at University of California, San Diego and Universidad de Guadalajara, researchers then ran simulations using weekly hospitalization data from the 2009 flu pandemic.

Here’s what they found: People who lived near a large commerce or job hub were at the biggest risk of contracting the flu. “If you commute there, you don’t have as much of a problem,” says study author Noel Brizuela, a graduate student at the University of California, San Diego. “If you live there, you’re in deep trouble.”

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Living near a busy commercial area or job zone is tricky because people (and their germs) come from all over to those areas, Brizuela explains. While commuters leave at the end of the day, people who live in those areas still regularly go to stores, restaurants, and public facilities that may have been infected with flu germs, increasing the odds they’ll come into contact with those germs.

Brizuela says he got the idea for the study after he rode on a bus that stopped near a hospital. “I noticed that everyone who was on the bus got off at the hospital, which probably meant they were sick,” he says. “I realized that I just spent 30 minutes trapped in a metal box with a bunch of sick people. That got me thinking that where you live determines how many sick people you encounter.”

Regardless of where you live, it’s crucial to do what you can to lower your odds of getting the flu. That’s why it’s important to get your flu shot each year and practice good hand hygiene, says infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.

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And, while Brizuela’s study found that people who lived in busy areas were at the highest risk of getting the flu, simply visiting crowded spaces also raises your risk. “The more you are in contact with people, the more likely you are to pick up a communicable disease,” Dr. Adalja says. “Everybody should be doing flu prevention methods, but it’s especially important in urban areas where you’re more likely to be exposed to influenza.”

In a perfect world, living and working in a suburb that also has all the services you need is ideal for having a lower flu risk, Brizuela says. Unfortunately, that's not currently the case—but according to the study authors, these findings can help public health officials develop better intervention strategies for illness outbreaks, or even design cities to reduce outbreaks altogether. 

To that end, Brizuela and his co-authors recommend that city officials work to have mixed zoning, where any area of a city can be developed for commerce, housing, or offices, in order to spread out large gathering areas and reduce outbreaks. “That way, people have jobs and shops near their house and don’t have to all travel to the same place to cover their necessities,” Brizuela says.

However, when you do travel to crowded areas, commuter zones, or job hubs, Dr. Adalja recommends doing your best to clean your hands and try to avoid people who appear to be sick. And, of course, getting your flu shot can help lower the odds you’ll actually get the flu and lessen the chances you’ll have serious complications if you do actually contract it.

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