In the study, Dr. Zarychanski and colleagues also found that First Nations ethnicity was associated with severe H1N1 disease requiring ICU admission. The proportion of First Nations people increased as the severity of disease increased; 28% of confirmed H1N1 cases in the community occurred in First Nations people, compared with 54% of hospital admissions and 60% of admissions to the ICU. Similar trends have been observed in Aboriginal communities in Australia and New Zealand. This is "consistent with historical records from the 1918 Spanish influenza pandemic, during which mortality in Aboriginal communities was far higher than in non-Aboriginal communities," write the authors.

While the authors note that a genetic predisposition hypothesis is interesting, Aboriginal peoples in Canada, Australia and the Torres Strait do not share common ancestry. "What they do have in common is a history of colonization, combined with historic and continuing social inequities that have led to significant health disparities," write the authors. They also suggest the increased risk for First Nations peoples may be because of substandard living conditions, low income, diet, additional health issues or lack of access to health care.

These findings may have implications for public, and health care provider education, as well as for future public health planning and community outreach programs in the face of the current, or future outbreaks.