Canadian First Nation (FN) populations were disproportionately effected by the 2009 H1N1 influenza pandemic. We investigate the odds of hospitalization and ICU admissions for cases of H1N1 among FN living in Manitoba, Canada, to assess if location of residency had an effect on access to healthcare services. We use logistic regression to calculate the odds of hospitalization adjusting for age, reservation residency, rurality, and disease wave. We find that FN individuals living on-reserve experienced higher odds of hospitalization than those living elsewhere, even controlling for rurality.