The 1,500 people who have come to L.A.'s QueensCare Family Clinics on Saturdays to get vaccinated against H1N1 flu have a lot in common: almost all are Hispanic, almost none have private insurance and, for the most part, almost all heard about the swine flu vaccine from a family member or friend.

And although clinic manager Catherine McLoughlin said some patients have expressed misgivings about the vaccine, it's nothing she hasn't heard from countless concerned moms about seasonal flu vaccines in past years.

"People are always concerned about injecting something into their bodies," McLoughlin said. "They ask, "Do I really need it? Will it make me sick?" and then they get it anyway."

If not even a language barrier stopped McLoughlin's patrons from getting dutifully vaccinated, it raises the question of why proportionately many more Latinos in California have died of swine flu than whites.

Last week the California Department of Public Health released figures showing that Latinos and blacks in California have been hospitalized for and died of H1N1 flu at far greater rates than whites have. Specifically, blacks were three times as likely to be hospitalized with H1N1 as whites are, while Latinos were twice as likely to die.


The trend is echoed in other parts of the country, as well. In Texas, Latinos comprise 37 percent of the state's population but 52 percent of total swine flu deaths. And in 13 cities monitored by the Centers for Disease Control and Prevention between April 15 and Aug. 31, 2009, 35 percent of people hospitalized with H1N1 were black, but they make up only 16 percent of the population.

Since viruses are colorblind, state epidemiologist Dr. Gilberto Chavez attempted to explain the disparity with a cryptic euphemism: blacks and Latinos have higher rates of chronic diseases, he said, adding that "for cultural reasons, they may be waiting too long to seek care."

Chavez was not available to clarify what he meant by "cultural reasons," but his office did suggest that they include affliction with other conditions, not having a primary care provider and a few other demographic factors. 

For example, "we know that H1N1 hit harder on young people," said Ken August, a state public health department representative. "The age range of Latino populations is younger than other ethnic groups, and children are more likely to be at risk."

But while "cultural reasons" cannot fully explain why H1N1 kills people of some races more than others, socio-economic ones can. In any case, there's no culture-based reluctance to protect against H1N1, according to Al Hernandez-Santana, executive director of the Latino Coalition for a Healthy California, a Sacramento advocacy group.

"The conclusions by the chief epidemiologist are flawed," he said in an e-mail interview. "There are no significant differences in cultural attitudes towards vaccination that we have seen. If anything, flu shots, polio vaccines and others have a long history of acceptance in Latino communities."

When controlling for insurance coverage, Latinos get seasonal flu shots at rates comparable to whites, according to data from the 2005 and 2007 California Health Interview Survey, and insured Latinos are vaccinated at slightly higher rates than insured whites.

The CDC has found that although very young and elderly blacks are less likely to be vaccinated than whites, black adults had higher flu vaccination rates than whites nationwide.

The state's H1N1 announcement was based on data collected before January of this year, when the H1N1 vaccine became more widely available. Prior to that, access to the vaccine was limited to only high-risk groups, so many Californians weren't necessarily able to get the vaccine, even if they wanted it.

But the vaccine's limited availability would have hit all races equally, meaning the racial disparity stems from underlying conditions: Latinos and blacks suffer from asthma, diabetes, obesity and kidney disease at far greater rates than whites do.

More so than youth or old age, those diseases can cause a simple H1N1 infection, which would ordinarily pass in a few days, to instead linger in the body and lead to complications and possibly death.

"If someone is sick to start off with, and they have an underlying condition, if you add flu on top of that, it's a tipping point," said Elizabeth Bancroft, a medical epidemiologist at L.A. County Department of Public Health.

And behind those underlying conditions lies the root cause for the health department's startling figures, and it has little to do with culture. In California, chronic diseases tend to afflict minorities more severely than whites with the same conditions, because in California, Latinos, blacks and Asians are all uninsured at much higher rates than whites.

Without health insurance, these groups are often unable to get treatment for their minor health problems before they turn into chronic conditions, much as they are unable to get treatment for their flu symptoms before they turn deadly.

"If you have diabetes and you're lucky enough to have an insulin pump, you're always checking your sugar and keeping it in check," Bancroft said. "But if you don't have an insulin pump and you can't afford the insulin test-strips, you have poorly controlled diabetes which puts you at a higher risk for infectious diseases."

Once an H1N1 infection takes hold of a person with an already compromised immune system, it can simmer in the body, frequently causing a bacterial pneumonia infection that fills the lungs with fluid.

"If you were already a little bit late to get your flu treated, that infection could be what ultimately kills you," Bancroft said.

To protect against that chain of events, Bancroft said people with lung diseases, asthma or other health problems should be vaccinated against bacterial pneumonia in addition to H1N1.

The pneumonia vaccine is harder to find, and its public information campaign pales in comparison to the state's aggressive outreach efforts in pushing H1N1 vaccination, Bancroft said. And while the H1N1 vaccine is available free of cost at most clinics, the pneumonia vaccine is not, making it harder for those without health insurance to obtain it.

Unfortunately, those are precisely ones who need it most.