Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory
Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory
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DOI：
10.5694/j.1326-5377.2010.tb03654.x
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发表时间：
2010-05-17
影响因子：
11.4
通讯作者：
Tong, Steven Y. C.
中科院分区：
文献类型：
--
作者：
Flint, Shaun M.;Davis, Joshua S.;Tong, Steven Y. C.
目的：描述2009年H1N1大流行性流感（nH 1 N1）对北领地高端社区、医院和重症监护室（ICU）的土著居民的影响。设计、设置和参与者：我们分析了2009年6月1日至8月31日期间的高端流感通报，以及通过高端急诊科收治的流感样疾病患者的数据。此外，前瞻性地收集和分析了皇家达尔文医院（RDH）和RDH ICU收治的nH 1 N1患者的数据。主要结果指标：根据土著身份分层的nH 1 N1病例的CDC调整通知率、nH 1 N1患者的高端医院入院率和nH 1 N1患者的RDH ICU入院率。研究期间共收到918份nH 1 N1报告。年龄调整后的nH 1 N1住院率为82/10万（95%置信区间，68-95）估计的常住人口总数，土著人口的比例明显高于非土著人口（269/100 000 vs 29/100 000 ERP;校正后的发生率比值为12 [95% CI，7.8-18]）。与住院相比，ICU入院的独立预测因素是缺氧（校正比值比[aOR]，4.5; CI，1.5-13.1）和胸部X线浸润（aOR，4.3; Cl，1.5-12.6）。结论：2009年H1N1流感大流行对高端的澳大利亚土著人产生了不成比例的影响，住院率高于澳大利亚其他地方和海外报道的住院率。这些发现对在土著人口众多的地区流感大流行期间规划医院和ICU的能力有影响。他们还确认需要改善健康和生活环境，并优先考虑在这一人群中接种疫苗。
Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels.Design, setting and participants: We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed.Main outcome measures: Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status.Results: There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% Cl, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; Cl, 1.5-12.6) on hospital admission.Conclusions: Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.