Indigenous groups are disproportionately impacted by influenza in numerous countries worldwide, including Canada, according to the first study to measure this issue on such a wide scale.
The study, published Thursday in the peer-reviewed journal PLOS One, found Indigenous people in the U.S., Canada, New Zealand and Australia were three to six times more likely to be hospitalized for influenza than non-Indigenous people in those countries.
In Canada, New Zealand and Australia, Indigenous people were more than five times as likely to be hospitalized with influenza.
“It is critical that governments ensure that people who have the flu have equitable access to healthcare and that vaccination rates are as high as possible,” Dr. Katherine Gibney, an epidemiologist at the Doherty Institute and Royal Melbourne Hospital as well as senior author of the study, said in a press release.
“When we are planning for seasonal flu, but especially pandemic flu, we need to have specific and targeted plans for First Nations people that are generated by First Nations people.”
Although this issue has been recorded in previous studies, researchers say this is the first time that this inequity has been estimated on a global scale.
Although influenza is a common illness, it still is responsible for thousands of deaths a year. There are more than 50 million influenza infections and more than 100,000 deaths due to influenza each year, according to this study.
And for Indigenous people, the rate of hospitalization and mortality is much higher, researchers say.
In order to get a broad picture of how Indigenous groups were impacted by influenza, researchers performed a review and meta-analysis of 36 studies that looked at data relating to influenza hospitalizations and deaths for Indigenous and non-Indigenous populations worldwide.
All of the studies were from high or high-middle income countries, with researchers noting there is a lack of studies on this topic from low-middle to low income countries. All studies were published prior to July 13, 2021.
Four of the studies had been performed in Canada, making up 11 per cent of the sample. The rest of the studies included 15 from Australia, 10 from the U.S., six from New Zealand and one from Brazil.
More than half of the studies had extractable data relating to hospitalization, while five had extractable data only relating to mortality. A total of 26 of the included studies were looking at hospitalizations and deaths that had occurred during the 2009 pandemic of H1N1, a type of influenza known as swine flu.
Across the board, researchers found there was a consistent pattern of Indigenous groups seeing statistically significant higher hospitalization rates.
When looking at seasonal influenza specifically, the biggest disparity was in Auckland, New Zealand, where Maori children were around eleven times more likely to be hospitalized for influenza compared to other children during the winter months of 2014-2016.
“For many global Indigenous populations, including those from Australia, Canada, New Zealand, the United States and Brazil, the experience of colonialism is the common factor driving health inequities,” researchers wrote in the study. “While particular circumstances differ between populations, the effects of violent dispossession from traditional lands, policies of exclusion and ongoing experiences of racism and discrimination, particularly within the healthcare sector, continue to unjustly manifest in worse health outcomes for Indigenous peoples.”
The study was limited by the lack of data from low income countries, as well as the lack of data focusing on seasonal influenza, with many of the studies focused on the H1N1 pandemic in 2009.
Gibney said governments should collaborate with Indigenous communities to address these inequities.
“Australia did a fantastic job during COVID of having First Nations-led plans that worked well,” she said. “And if that can be applied to the flu, it would be incredibly valuable.”
“Our research emphasises the widespread and ongoing impacts of colonisation on the health outcomes of First Nations communities,” Dr. Juliana Betts, co-author of the study with Monash University, added in the release.
“Solutions to these health gaps largely sit outside of the health sector, in policies that address the many social determinants of health including poverty, housing, education and racism.”
Researchers are also calling for better data to be gathered, so the factors behind this inequity can be explored further.
“When we get information about flu hospitalisations and deaths, we need to capture that individual’s First Nations status to determine whether the gap we have described is closing over time, and to continue to advocate for resources to reduce the disease burden in First Nations populations,” Gibney said.
