Why are Native Americans more likely to die of flu?

New America Media

Sep 10, 2010

ALBUQUERQUE, N.M.— American Indians are four times more likely to die of the flu than other Americans, but experts aren’t sure why. That’s according to a 12-state study by the U.S. Centers for Disease Control and Prevention which also looked at vaccination rates.

“The difference in American Indian death rates is not due to a difference in vaccination rates,” Dr. John Redd of the Indian Health Service, a federal health program for Native Americans, told members of ethnic media at a recent New America Media news briefing in Albuquerque. “Nor do we think that just being American Indian itself is a risk factor,” he added.

The major factor health observers have found, he says, is that American Indians are more likely to have chronic health conditions such as diabetes and asthma. That’s one possible reason that could explain the high death rates.

American Indians, who make up nearly 10 percent of the population of New Mexico, had the highest rate of flu-related hospitalization and death of any ethnic group in the state during last year’s H1N1 epidemic. Dr. Joan Baumbach, a medical epidemiologist who conducts influenza surveillance for the New Mexico Department of Health, found that their hospitalization rate (90 out of 100,000) was twice that of African Americans and more than three times that of whites.

Their death rate from the flu (five out of 100,000) was twice that of Hispanics, the second most affected group.

Although health officials may not be certain why this is true, they agreed that the best way to counteract these effects is by increasing awareness and vaccination rates across all communities in New Mexico. The state currently has a 25 percent vaccination rate, similar to the national average, but the numbers are lower among African Americans and Latinos, according to Amy Groom, a CDC public health adviser assigned to Indian Health Service.

Baumbach adds that misconceptions about the flu vaccine persist in all populations. The flu, she says, is “definitely preventable, but the question is, what are we preventing?” People who get the vaccine, she said, “may get the flu, but (the vaccine) prevented hospitalization. Or they may get hospitalized, but (the vaccine) prevented death. There are degrees of prevention.” Yet many Americans are still hesitant to get the vaccine.

“It’s unreal that I can’t even persuade my own husband to get the flu shot,” said Arleen Porcell-Pharr, a public affairs specialist at the CDC in Atlanta. She said her husband resisted the vaccine until he knew someone personally who died from the flu. “One day he came home somber and said, ‘I just heard that an elementary school classmate died from the swine flu.’ That was the moment,” she said, when he decided to get the vaccine. In New Mexico, where nearly half the population is Latino (45.6 percent according to the 2009 figures from the U.S. Census Bureau), language, poverty, and fears over immigration status can be barriers to accessing information about the vaccine.

“We’re going to have more Hispanics moving here, people who don’t speak English,” said Sandra Chavez of Radio Lobo in Albuquerque. “We need to make sure the message gets to Hispanic homes.” Pablo Gutierrez, producer of Univision Ch. 41, said that last year his station received a number of calls from viewers who were afraid they would be asked for their papers, or who could not afford the cost of the vaccine. “Twenty to 25 dollars is a lot for many of our families that live in extreme poverty,” said Francisco Ronquillo, a regional coordinator with the University of New Mexico’s Health Sciences Center.

The most successful programs, said Ronquillo, involve making the vaccine accessible – from the promotora model of health workers who go out into the communities, to a school immunization project that Ronquillo has been working on to provide the vaccination through local schools. Experts hope that last year’s H1N1 epidemic increased the public’s awareness about the importance of getting the flu shot.

Last year, more than 61 million people got the flu virus and 13,000 people died from it in the United States, according to Purcell-Pharr. This year’s seasonal flu shot includes vaccines against influenza A H1N1 (the so-called “swine flu” that became an epidemic last year), influenza A H3N1 (a virus that is now spreading) and influenza B.

The seasonal flu shot is recommended for anyone who is 6 months or older, and is particularly recommended for vulnerable populations such as elders, ethnic minorities, pregnant women, and anyone with a chronic disease such as asthma, diabetes type 1 or 2, or HIV/AIDS. More information is at cdc.gov/flu.