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So far, swine flu has proven less deadly than originally anticipated. But it has taken a serious toll on one demographic category: American Indians and Alaska Natives. They are four times more likely to die of H1N1 than members of any other racial or ethnic group. That's according to a report released this month by the Centers for Disease Control and Prevention.

Laurel Morales of Arizona Public Radio tried to find out the reasons for that disparity.

LAURA MORALES: It's a quiet morning at Phil Stago's home. He and his family live a tiny house in the tiny town of Winslow, Arizona, just outside the vast Navajo Nation. His 2-year-old watches cartoons and snuggles with her dad while the baby rocks in a swing. The mellow morning is quite a switch from the drama the family experienced in September. The Stagos were hit hard by swine flu.

Mr. PHIL STAGO: It just totally wiped them out for about a month. The whole family was sick for about a month.

MORALES: Stago says first his son got it � itchy throat, fever and aches - then 2-year-old Alicia picked up the virus.

(Soundbite of baby)

MORALES: She's feeling much better now. But when her newborn sister, Gabriela, caught swine flu, things got scary. They live in a rural desert town. Luckily, there's an Indian health service clinic and a hospital nearby. And the baby was taken to the hospital as soon as her fever hit 100.

Mr. STAGO: They secluded us from her, and they put her in a little tank of oxygen. Had to wear the whole - full isolation gowns and gloves and mask. That's pretty scary.

MORALES: Flagstaff Medical Center, about an hour west of Winslow, is a referral hospital for nearby reservations. On this day, at the peak of the second wave of the swine flu virus a few weeks ago, the intensive care unit is almost full of American Indian people on respiratory ventilators.

Pulmonologist Michael Reedy(ph).

Dr. MICHAEL REEDY (Pulmonologist): We locally are certainly seeing a large percentage of Native Americans affected.

MORALES: That's true across the state. In Arizona, of the more than 1,600 people hospitalized for swine flu, 13 percent have been American Indian. Yet American Indians only account for 5 percent of all Arizonans. In Canada, First Nation groups, and in Australia, Aboriginal tribes, have reported similar disproportionate findings.

There are plenty of theories and speculation as to why indigenous people are more at risk. John Redd is an epidemiologist for the Indian Health Service.

Dr. JOHN REDD (Epidemiologist, Indian Health Service): When you think of risk factors for influenza - crowding, for example; poor housing - those are more present in many indigenous populations around the world.

MORALES: In addition to poverty, Redd also points out that American Indians are prone to diabetes and asthma. When you combine the swine flu with these pre-existing conditions, the outcomes are worse.

Access to health care is also an issue. There are a dozen Indian health- care centers scattered throughout the Navajo Nation, but the reservation is the size of West Virginia. Native American clinical nurse manager Cindy Galloway believes there's something else.

Ms. CINDY GALLOWAY (Clinical Nurse Manager): They are more stoic people. They don't complain, frankly.

MORALES: Galloway says it's typical for an American Indian patient to wait until their symptoms become severe before they seek treatment.

Ms. GALLOWAY: And that's what I've seen, is that people will tolerate feeling bad longer and thinking it's going to go away. When finally after four or five days they can't even take a deep breath, then they realize that this could be more serious.

MORALES: Indian Health Service officials say many people have been exposed to swine flu or had been vaccinated now. So, there is hope that the next possible wave of the virus, which could come as early as January, won't be as severe.

For NPR News, I'm Laura Morales in Flagstaff.

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