Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
Continuing Education and Professional Development, University of Toronto, Toronto, ON, Canada.
Influenza Other Respir Viruses. 2013 Sep;7 Suppl 2(Suppl 2):54-58. doi: 10.1111/irv.12082.
Previous reviews found that the H1N1 pandemic was associated with a large proportion of hospitalizations, severe illness, workplace absenteeism, and high costs. However, the burden among socially disadvantaged groups of the population is unclear. This is a summary of a previously published systematic review commissioned by the World Health Organization on the burden of H1N1 pandemic (influenza A/Mexico/2009 (H1N1)) among socially disadvantaged populations.
MEDLINE and EMBASE were searched to identify studies reporting hospitalization, severe illness, and mortality attributable to the 2009 H1N1 pandemic among socially disadvantaged populations, including ethnic minorities and low-income or lower-middle-income economy countries (LIC/LMIC). SAS and Review Manager were used to conduct random effects meta-analysis.
Forty-eight cohort studies and 14 companion reports including 44 777 patients were included after screening 787 citations and 164 full-text articles. Twelve of the included studies provided data on LIC/LMIC, including one study from Guatemala, two from Morocco, one from Pakistan, and eight from India, plus four companion reports. The rest provided data on ethnic minorities living in high-income economy countries (HIC). Significantly more hospitalizations were observed among ethnic minorities versus nonethnic minorities in two North American studies [1313 patients, odds ratio (OR) 2·26 (95% confidence interval: 1·53-3·32)]. Among hospitalized patients in HIC, statistically significant differences in intensive care unit admissions (n = 8 studies, 15 352 patients, OR 0·84 [0·69-1·02]) and deaths (n = 6 studies, 14 757 patients, OR 0·85 [95% CI: 0·73-1·01]) were not observed.
We found significantly more hospitalizations among ethnic minorities versus nonethnic minorities in North America, yet no differences in intensive care unit admissions or deaths among H1N1-infected hospitalized patients were observed in North America and Australia. Our results suggest a similar burden of H1N1 between ethnic minorities and nonethnic minorities living in HIC.
之前的综述发现，H1N1 大流行与大量住院、严重疾病、工作场所缺勤和高成本有关。然而，社会弱势群体的负担情况尚不清楚。这是世界卫生组织委托对社会弱势群体（包括少数民族和低收入或中低收入经济体国家）中甲型 H1N1 大流行（流感 A/墨西哥/2009（H1N1））负担情况进行的一项已发表系统综述的摘要。
通过 MEDLINE 和 EMBASE 检索，以确定报告社会弱势群体中 2009 年 H1N1 大流行导致住院、严重疾病和死亡的研究，包括少数民族和低收入或中低收入经济体国家（LIC/LMIC）。使用 SAS 和 Review Manager 进行随机效应荟萃分析。
经过筛选 787 条引文和 164 篇全文文章后，纳入了 48 项队列研究和 14 份伴随报告，共包括 44777 名患者。其中 12 项纳入研究提供了 LIC/LMIC 的数据，包括来自危地马拉的一项研究、摩洛哥的两项研究、巴基斯坦的一项研究和印度的八项研究，以及四项伴随报告。其余研究提供了生活在高收入经济体国家的少数民族的数据。在两项北美研究中，少数民族与非少数民族相比，住院人数明显更多[1313 例患者，比值比（OR）2.26（95%置信区间：1.53-3.32）]。在高收入经济体国家的住院患者中，未观察到重症监护病房入院率（n=8 项研究，15352 例患者，OR 0.84（0.69-1.02））和死亡率（n=6 项研究，14757 例患者，OR 0.85（95%CI：0.73-1.01））的统计学显著差异。
我们发现，在北美，少数民族与非少数民族相比，住院人数明显更多，但在北美和澳大利亚，未观察到甲型 H1N1 感染住院患者的重症监护病房入院率或死亡率存在差异。我们的结果表明，生活在高收入经济体国家的少数民族和非少数民族的 H1N1 负担相似。
