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ATLANTA (AP) — Health officials say American Indians and Alaska Natives have died from swine flu at a rate four times greater than other Americans.

The Centers for Disease Control and Prevention on Thursday released a study of swine flu deaths in 12 states. They found that 42 American Indians and Alaska Natives in those states died of swine flu or its complications. That was a rate of nearly 4 out of every 100,000 people in that group.

American Indians and Alaska Natives have higher rates of diabetes, asthma and other conditions that make them more vulnerable. The study is being published in the CDC's Morbidity and Mortality Weekly Report.