Influenza hospitalizations among American Indian/Alaska Native people and in the United States general population

Prabhu P. Gounder, Laura S. Callinan, Robert C. Holman, Po Yung Cheng, Michael G. Bruce, John T. Redd, Claudia A. Steiner, Joseph Bresee, Thomas W. Hennessy

Research output: Contribution to journalArticlepeer-review


Background. Historically, American Indian/Alaska Native (AI/AN) people have experienced a disproportionate burden of infectious disease morbidity compared with the general US population. We evaluated whether a disparity in influenza hospitalizations exists between AI/AN people and the general US population. Methods. We used Indian Health Service hospital discharge data (2001-2011) for AI/AN people and 13 State Inpatient Databases (2001-2008) to provide a comparison to the US population. Hospitalization rates were calculated by respiratory year (July-June). Influenza-specific hospitalizations were defined as discharges with any influenza diagnoses. Influenza-associated hospitalizations were calculated using negative binomial regression models that incorporated hospitalization and influenza laboratory surveillance data. Results. The mean influenza-specific hospitalization rate/100 000 persons/year during the 2001-2002 to 2007-2008 respiratory years was 18.6 for AI/AN people and 15.6 for the comparison US population. The age-adjusted influenza-associated hospitalization rate for AI/AN people (98.2; 95% confidence interval [CI], 51.6-317.8) was similar to the comparison US population (58.2; CI, 34.7-172.2). By age, influenza-associated hospitalization rates were significantly higher among AI/AN infants (< 1 year) (1070.7; CI, 640.7-2969.5) than the comparison US infant population (210.2; CI, 153.5-478.5). Conclusions. American Indian/Alaska Native people had higher influenza-specific hospitalization rates than the comparison US population; a significant influenza-associated hospitalization rate disparity was detected only among AI/AN infants because of the wide CIs inherent to the model. Taken together, the influenza-specific and influenzaassociated hospitalization rates suggest that AI/AN people might suffer disproportionately from influenza illness compared with the general US population.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Issue number1
StatePublished - Mar 1 2014
Externally publishedYes


  • American Indian
  • Epidemiology
  • Healthcare disparities
  • Influenza

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology


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