A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1): is American Indian racial status an independent risk factor?
A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1): is American Indian racial status an independent risk factor?
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一项案例对照研究研究了2009年大流行性流感A（H1N1）死亡风险因素：美洲印第安人种族地位是独立的危险因素吗？
DOI：
10.1017/s0950268815001211
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发表时间：
2016-01
影响因子：
4.2
通讯作者：
Investigative Team
中科院分区：
文献类型：
--
作者：
Hennessy TW;Bruden D;Castrodale L;Komatsu K;Erhart LM;Thompson D;Bradley K;O'Leary DR;McLaughlin J;Landen M;Investigative Team
从历史上看，美洲印第安人/阿拉斯加原住民（AI/AN）遭受了流感的过度发病率和死亡率。我们调查了居住在五个有大量AI/AN人群的州的人死于2009年甲型H1N1流感的危险因素。我们利用2009年阿拉斯加、亚利桑那、新墨西哥州、俄克拉荷马州和怀俄明州的流感死亡病例进行了病例对照研究。对照组为门诊流感患者。我们回顾了医疗记录，并采访了病例代理人和对照组。我们使用多重插补来预测缺失数据，使用多变量条件logistic回归来确定危险因素。我们纳入了145例致死性病例和236例对照; 22%的病例为AI/AN。风险因素（p值< 0.05）包括：年龄较大（校正匹配比值比[OR] 3.2，> 45岁）。与< 18岁相比）、既存疾病（OR 7.1）、吸烟（OR 3.0）、延迟接受抗病毒药物（莫尔6.5）和获得医疗保健的障碍（OR 5.3）。AI/AN种族与死亡无显著相关性。AI/AN中流感死亡率的增加是由于种族状况以外的因素。预防流感死亡应侧重于可改变的因素（吸烟、早期使用抗病毒药物、获得护理），并确定高风险人群进行免疫接种和及时就医。
Historically, American Indian/Alaska Native populations (AI/AN) have suffered excess morbidity and mortality from influenza. We investigated the risk factors for death from 2009 pandemic influenza A (H1N1) among 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-value < 0.05) included: older age (adjusted matched odds ratio [OR] 3.2, for > 45 years. vs. < 18 years), pre-existing medical conditions (OR 7.1), smoking (OR 3.0), delayed receipt of antivirals (MOR 6.5), and barriers to healthcare access (OR 5.3). AI/AN race was not significantly associated with death. The increased influenza mortality among AI/ANs 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.