title: The impact of geographical location of residence on disease outcomes among Canadian First Nations populations during the 2009 influenza A(H1N1) pandemic.
abstract: We sought to evaluate the effect of geographical location of residence on disease burden in Canadian First Nations (FN) populations during the 2009 pandemic influenza A(H1N1). Descriptive statistics and regression analysis of data for cases of pandemic A(H1N1) infection and hospitalization in the province of Manitoba, Canada, were conducted to estimate the odds of hospitalization and delay in time-to-hospitalization for on-reserve and off-reserve FN populations, while considering their geographical proximity to urban centers. We found that on-reserve FN individuals experienced a longer delay between infection and hospitalization compared to off-reserve FN individuals (p<0.001). The average fraction of FN cases that experienced a delay longer than 4 days for hospitalization was 20% higher for on-reserve compared to off-reserve residence. The odds of hospitalization were twice as high for FN people living on-reserve as compared to off-reserve (odds ratio=2.34; 95% CI: 1.16-4.73). Given the independent effect of on-reserve residency, higher disease burden among FN people cannot be attributed entirely to limited healthcare access due to remoteness from urban centers.
authors.affiliation: Surveillance Laboratory, McGill Clinical and Health Informatics, McGill University, Montreal, Quebec, Canada H3A 1A3; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A 1A3.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Morrison
authors.affiliation: Surveillance Laboratory, McGill Clinical and Health Informatics, McGill University, Montreal, Quebec, Canada H3A 1A3; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A 1A3.
authors.forename: David L
authors.initials: DL
authors.lastname: Buckeridge
authors.affiliation: Agent-Based Modelling Laboratory, York Institute for Health Research, York University, Toronto, Ontario, Canada M3J 1P3. Electronic address: yanyuxiao@gmail.com.
authors.forename: Yanyu
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Agent-Based Modelling Laboratory, York Institute for Health Research, York University, Toronto, Ontario, Canada M3J 1P3.
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Moghadas
mesh_terms: D004196:Disease Outbreaks; D062306:Geography, Medical; D006801:Humans; D007198:Indians, North American; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000208:ethnology*; D008350:Manitoba / Q000453:epidemiology
keywords: Aboriginal health; Descriptive statistics; Influenza A(H1N1); Influenza surveillance; Rural health