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Influenza Other Respir Viruses. 2013 Sep;7 Suppl 2:54-8. doi: 10.1111/irv.12082.

Impact of H1N1 on socially disadvantaged populations: summary of a systematic review.

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1
Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.

Abstract

BACKGROUND:

Previous reviews found that the H1N1 pandemic was associated with a large proportion of hospitalizations, severe illness, workplace absenteeism, and high costs. However, the burden among socially disadvantaged groups of the population is unclear. This is a summary of a previously published systematic review commissioned by the World Health Organization on the burden of H1N1 pandemic (influenza A/Mexico/2009 (H1N1)) among socially disadvantaged populations.

METHODS:

MEDLINE and EMBASE were searched to identify studies reporting hospitalization, severe illness, and mortality attributable to the 2009 H1N1 pandemic among socially disadvantaged populations, including ethnic minorities and low-income or lower-middle-income economy countries (LIC/LMIC). SAS and Review Manager were used to conduct random effects meta-analysis.

RESULTS:

Forty-eight cohort studies and 14 companion reports including 44 777 patients were included after screening 787 citations and 164 full-text articles. Twelve of the included studies provided data on LIC/LMIC, including one study from Guatemala, two from Morocco, one from Pakistan, and eight from India, plus four companion reports. The rest provided data on ethnic minorities living in high-income economy countries (HIC). Significantly more hospitalizations were observed among ethnic minorities versus nonethnic minorities in two North American studies [1313 patients, odds ratio (OR) 2·26 (95% confidence interval: 1·53-3·32)]. Among hospitalized patients in HIC, statistically significant differences in intensive care unit admissions (n = 8 studies, 15 352 patients, OR 0·84 [0·69-1·02]) and deaths (n = 6 studies, 14 757 patients, OR 0·85 [95% CI: 0·73-1·01]) were not observed.

CONCLUSION:

We found significantly more hospitalizations among ethnic minorities versus nonethnic minorities in North America, yet no differences in intensive care unit admissions or deaths among H1N1-infected hospitalized patients were observed in North America and Australia. Our results suggest a similar burden of H1N1 between ethnic minorities and nonethnic minorities living in HIC.

KEYWORDS:

Ethnic minority; H1N1 subtype; influenza A; low-income country; low-middle-income country; vulnerable populations

PMID:
24034485
DOI:
10.1111/irv.12082
[Indexed for MEDLINE]
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