2 research outputs found
A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1): Is American Indian racial status an independent risk factor?
Historically, American Indian/Alaska Native ( AI/AN ) populations have suffered excess morbidity and mortality from influenza. We investigated the risk factors for death from 2009 pandemic influenza A( H1N1 ) in persons residing in five states with substantial AI/AN populations. We conducted a case-control investigation using pandemic influenza fatalities from 2009 in Alaska, Arizona, New Mexico, Oklahoma and Wyoming. Controls were outpatients with influenza. We reviewed medical records and interviewed case proxies and controls. We used multiple imputation to predict missing data and multivariable conditional logistic regression to determine risk factors. We included 145 fatal cases and 236 controls; 22% of cases were AI/AN. Risk factors ( P 45 years vs. < 18 years], pre-existing medical conditions ( mOR 7路1 ), smoking ( mOR 3路0 ), delayed receipt of antivirals ( mOR 6路5 ), and barriers to healthcare access ( mOR 5路3 ). AI/AN race was not significantly associated with death. The increased influenza mortality in AI/AN individuals was due to factors other than racial status. Prevention of influenza deaths should focus on modifiable factors ( smoking, early antiviral use, access to care ) and identifying high-risk persons for immunization and prompt medical attention