Swine flu disproportionately hits the young and the asthmatic, the pregnant and the diabetic.

A federal study says American Indians also are at high risk.

American Indians and Alaska Natives are four times more likely to die from H1N1 than all other ethnic groups combined, according to a Centers for Disease Control and Prevention study that looked at the indigenous population in 12 states, representing half of America's total.

"That's something we have to think about when we do vaccine efforts," said Dr. David Sprenger, chief medical officer at the California Area Indian Health Service, the federal health program for American Indians and Alaska Natives. "We really have to make a push to get Native Americans vaccinated."

California, which has a large number of the nation's American Indians, was not part of the CDC study.

State data seem to indicate California's American Indians are not at a significantly greater risk for getting a severe case of swine flu.

The four American Indians in California who died of H1N1 complications accounted for 1 percent of the state's swine flu deaths between April 2009 and Jan. 2, according to the state Public Health Department.

They accounted for 1 percent of the state's intensive care unit cases in the same period.

American Indians and Alaska Natives account for 0.8 percent of the state's population, according to the U.S. Census Bureau's 2008 American Community Survey.

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