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. 2023 Apr 13;3(4):e0001294.
doi: 10.1371/journal.pgph.0001294. eCollection 2023.

Influenza-associated hospitalisation and mortality rates among global Indigenous populations; a systematic review and meta-analysis

Juliana M Betts  1 , Aaron L Weinman  2 , Jane Oliver  2 , Maxwell Braddick  2   3 , Siyu Huang  2   4 , Matthew Nguyen  2 , Adrian Miller  5 , Steven Y C Tong  2   3 , Katherine B Gibney  2   3
Affiliations

Influenza-associated hospitalisation and mortality rates among global Indigenous populations; a systematic review and meta-analysis

Juliana M Betts et al. PLOS Glob Public Health. .

Abstract

Background: More than 50 million influenza infections and over 100,000 deaths from influenza occur annually. While Indigenous populations experience an inequitable influenza burden, the magnitude of this inequity has not previously been estimated on a global scale. This study compared rates of influenza-associated hospitalisation and mortality between Indigenous and non-Indigenous populations globally.

Methods: A systematic review and meta-analysis was conducted including literature published prior to 13 July 2021. Eligible articles either reported a rate ratio (RR) comparing laboratory-confirmed influenza-associated hospitalisation and/or mortality between an Indigenous population and a corresponding benchmark population, or reported sufficient information for this to be calculated using publicly available data. Findings were reported by country/region and pooled by country and period (pandemic/seasonal) when multiple studies were available using a random-effects model. The I2 statistic assessed variability between studies.

Results: Thirty-six studies (moderate/high quality) were included; all from high or high-middle income countries. The pooled influenza-associated hospitalisation RR (HRR) for indigenous compared to benchmark populations was 5·7 (95% CI: 2·7-12·0) for Canada, 5·2 (2.9-9.3) for New Zealand, and 5.2 (4.2-6.4) for Australia. Of the Australian studies, the pooled HRR for seasonal influenza was 3.1 (2·7-3·5) and for pandemic influenza was 6·2 (5·1-7·5). Heterogeneity was slightly higher among studies of pandemic influenza than seasonal influenza. The pooled mortality RR was 4.1 (3·0-5.7) in Australia and 3·3 (2.7-4.1) in the United States.

Conclusions: Ethnic inequities in severe influenza persist and must be addressed by reducing disparities in the underlying determinants of health. Influenza surveillance systems worldwide should include Indigenous status to determine the extent of the disease burden among Indigenous populations. Ethnic inequities in pandemic influenza illustrate the need to prioritise Indigenous populations in pandemic response plans.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of included studies.
Fig 2
Fig 2. Overall influenza-associated hospitalisation rate ratios (HRR) for Indigenous populations compared with a benchmark population by country.
Fig 3
Fig 3. Seasonal and pandemic influenza-associated hospitalisation rate ratios (HRR) from Australian studies for Indigenous populations compared with a benchmark population.
Fig 4
Fig 4. Overall influenza-associated mortality rate ratios (MRR) by country for Indigenous peoples compared with a benchmark population.
See this image and copyright information in PMC

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