摘要：Objectives. We conducted the first empirical examination of disparities in H1N1 exposure, susceptibility to H1N1 complications, and access to health care during the H1N1 influenza pandemic. Methods. We conducted a nationally representative survey among a sample drawn from more than 60 000 US households. We analyzed responses from 1479 adults, including significant numbers of Blacks and Hispanics. The survey asked respondents about their ability to impose social distance in response to public health recommendations, their chronic health conditions, and their access to health care. Results. Risk of exposure to H1N1 was significantly related to race and ethnicity. Spanish-speaking Hispanics were at greatest risk of exposure but were less susceptible to complications from H1N1. Disparities in access to health care remained significant for Spanish-speaking Hispanics after controlling for other demographic factors. We used measures based on prevalence of chronic conditions to determine that Blacks were the most susceptible to complications from H1N1. Conclusions. We found significant race/ethnicity-related disparities in potential risk from H1N1 flu. Disparities in the risks of exposure, susceptibility (particularly to severe disease), and access to health care may interact to exacerbate existing health inequalities and contribute to increased morbidity and mortality in these populations. In 2008, Blumenshine et al. proposed a model in which differences in social position (e.g., income, race/ethnicity) could cause disparities in exposure to influenza, unequal levels of susceptibility to illness if exposed, differential access to prophylaxis before disease develops, and differential access to treatment after disease develops. 1 The model held that these disparities could synergistically lead to unequal levels of morbidity and mortality. 1 We used this model to examine disparities in the 2009 H1N1 influenza pandemic. As of October 2009, the Centers for Disease Control and Prevention (CDC) had recorded widespread H1N1 influenza activity in 46 states, and visits to health care facilities had increased sharply. 2 There were also increasing reports of racial/ethnic disparities in H1N1 complications and hospitalization rates. 3 – 11 Boston and Chicago officials reported an overrepresentation of Blacks and Hispanics (and Asian/Pacific Islanders in Chicago) among hospitalized cases. 3 , 9 Oklahoma documented a disparity in race/ethnicity specific incidence rates per 100 000 for hospitalized cases; among the 1081 cases reported, the rates were highest for Blacks (55%) and Native Americans (37%) and lowest for Whites (26%). 12 Speculation about causes of this disproportionate impact has focused on crowded living conditions, differential exposure, lower income, distrust of government, and susceptibility to complications caused by chronic diseases. 3 , 8 , 9 , 11 We used the model of Blumenshine et al. (further described below) in an effort to understand this pandemic and prevent unnecessary suffering as a result of it.
