{
  "abstract": "Prior work has shown that school-age childrens influenza activity precedes that of adults by one to two weeks. Whether this is robust across outcomes or constant across a seasons course is unexamined.\n\nUsing electronic health record data from two health systems in South Carolina (2016-2026) on individuals with an influenza diagnosis or positive test, we tested age-group lead-lag relationships across six measures using differenced cross-correlation and Granger causality, with significance confirmed via heteroskedasticity-robust block permutation. We tested whether relationships differed between a seasons growth and decline phases.\n\nChildren 5-17 years led every other age group by approximately one week in four out of six outcomes and were the only group showing any nonzero-lag relationship across 60 pairwise combinations. A screen of 150 source-target combinations identified 26 permutation-confirmed instances of childrens lower-acuity activity preceding elevated emergency department or inpatient burden in other age groups. The same-outcome lead was concentrated during a seasons growth phase, while the cross-severity lead was robust throughout both a seasons growth and decline.\n\nSchool-age childrens influenza activity is a robust, multi-outcome leading indicator with distinct transmission-timing and severity-progression signals in different phases of seasonal epidemics, supporting incorporation of age-stratified, phase-aware indicators into influenza forecasting.",
  "abstract_shown": true,
  "affiliations": [
    "Clemson University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. A. Serman"
    },
    {
      "name": "A. Bleichrodt"
    },
    {
      "name": "I. Jayawardena"
    },
    {
      "name": "C. Liskey"
    },
    {
      "name": "L. Rennert"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c2symbsstz4xd.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.29.26364022",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.29.26364022v1.full",
  "id": "c2symbsstz4xd",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.29.26364022v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2713|Influenza Virus Research Studies"
    ]
  ],
  "openalex": "W7220380095",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.29.26364022v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c2symbsstz4xd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.64898/2026.09.29.26364022",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.29.26364022v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Age as a Leading Indicator: A Multi-Outcome Analysis of Influenza Lead-Lag Relationships",
  "title_text": "Age as a Leading Indicator: A Multi-Outcome Analysis of Influenza Lead-Lag Relationships",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/c2symbsstz4xd",
  "venue": "medRxiv",
  "versions": []
}