摘要：Objectives. We assessed the impact of social determinants of potential exposure to H1N1—which are unequally distributed by race/ethnicity in the United States—on incidence of influenza-like illness (ILI) during the 2009 H1N1 pandemic. Methods. In January 2010 we surveyed a nationally representative sample (n = 2079) of US adults from the Knowledge Networks online research panel, with Hispanic and African American oversamples. The completion rate was 56%. Results. Path analysis examining ILI incidence, race, and social determinants of potential exposure to H1N1 demonstrated that higher ILI incidence was related to workplace policies, such as lack of access to sick leave, and structural factors, such as number of children in the household. Hispanic ethnicity was related to a greater risk of ILI attributable to these social determinants, even after we controlled for income and education. Conclusions. The absence of certain workplace policies, such as paid sick leave, confers a population-attributable risk of 5 million additional cases of ILI in the general population and 1.2 million cases among Hispanics. Federal mandates for sick leave could have significant health impacts by reducing morbidity from ILI, especially in Hispanics. During the 2009 H1N1 pandemic, racial/ethnic disparities in hospitalization and mortality rates were reported in the United States. 1–8 Non-Hispanic Blacks and Hispanics were overrepresented among hospitalized cases compared with non-Hispanic Whites. 3,7 It is unclear whether these disparities were attributable to unequal levels of incidence resulting from disparities in exposure by race/ethnicity, unequal levels of underlying chronic conditions, or unequal access to health care leading to differences in timely care-seeking behaviors. We assessed the impact of social determinants of potential exposure to the virus, which are unequally distributed by race/ethnicity in the United States, on influenza-like illness (ILI) incidence.
