Trends in infectious disease hospitalizations among American Indians and Alaska Natives.

OBJECTIVES: This study sought to describe trends in hospitalizations associated with infectious diseases among American Indians and Alaska Natives. METHODS: Infectious disease hospitalizations and rates among American Indians and Alaska Natives from 1980 through 1994 were examined via Indian Health Service hospital discharge data and compared with published trends for the general US population. RESULTS: Annual hospitalization rates for infectious diseases among American Indians and Alaska Natives decreased by 31.0% between 1980 and 1994. Infectious disease hospitalizations accounted for 16.3% of all hospitalizations in 1980 and 21.2% in 1994, an increase of 30.1%. In 1994, the age-adjusted infectious disease hospitalization rate for American Indians and Alaska Natives was 1863 per 100,000 population, approximately 21% greater than that for the general US population. CONCLUSIONS: Hospitalization trends for infectious diseases show that there has been improvement in the health status of American Indians and Alaska Natives but also indicate that this population has a higher infectious disease burden than the general US population.

Trends in intussusception-associated hospitalizations and deaths among US infants.

CONTEXT: The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants. OBJECTIVE: To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants. DESIGN: This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988-1997, Indian Health Service (IHS) for 1980-1997, California for 1990-1997, Indiana for 1994-1998, Georgia for 1997-1998, and MarketScan for 1993-1996, and mortality data from the national multiple cause-of-death data for 1979-1997 and linked birth/infant death data for 1995-1997. PATIENTS: Infants (<1 year old) with an International Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively. RESULTS: During 1994-1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9-35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33-79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980-1982 to 12 per 100 000 during 1995-1997 (relative risk =7.6, 95% CI = 3.2-18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979-1981 to 2.3 per 1 000 000 live births during 1995-1997 (relative risk = 2.8, 95% CI = 1.8-4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death. CONCLUSIONS: Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants.

Bronchiolitis-associated hospitalizations among American Indian and Alaska Native children.

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and young children. Respiratory system diseases account for a large proportion of hospitalizations in American Indian and Alaska Native (AI/AN) children; however, aggregate estimates of RSV-associated hospitalizations among AI/AN children have not been made. METHODS: We used Indian Health Service hospitalization data from 1990 through 1995 to describe hospitalizations associated with bronchiolitis, the most characteristic clinical manifestation of RSV infection, among AI/AN children <5 years old. RESULTS: The overall bronchiolitis-associated hospitalization rate among AI/AN infants < 1 year old was considerably higher (61.8 per 1,000) than the 1995 estimated bronchiolitis hospitalization rate among all US infants (34.2 per 1,000). Hospitalization rates were higher among male infants (72.2 per 1,000) than among females infants (51.1 per 1,000). The highest infant hospitalization rate was noted in the Navajo Area (96.3 per 1,000). Hospitalizations peaked annually in January or February, consistent with national peaks for RSV detection. Bronchiolitis hospitalizations accounted for an increasing proportion of hospitalizations for lower respiratory tract illnesses. CONCLUSIONS: Bronchiolitis-associated hospitalization rates are substantially greater for AI/AN infants than those for all US infants. This difference may reflect an increased likelihood of severe RSV-associated disease or a decreased threshold for hospitalization among AI/AN infants with bronchiolitis compared with all US infants. AI/AN children would receive considerable benefit from lower respiratory tract illness prevention programs, including an RSV vaccine, if and when one becomes available.

Incidence of Rocky Mountain spotted fever among American Indians in Oklahoma.

OBJECTIVE: Although the state of Oklahoma has traditionally reported very high incidence rates of Rocky Mountain spotted fever (RMSF) cases, the incidence of RMSF among the American Indian population of the state has not been studied. The authors used data from several sources to estimate the incidence of RMSF among American Indians in Oklahoma. METHODS: The authors retrospectively reviewed an Indian Health Service (IHS) hospital discharge database for 1980-1996 and available medical charts from four IHS hospitals. The authors also reviewed RMSF case report forms submitted to the Centers for Disease Control and Prevention (CDC) for 1981-1996. RESULTS: The study data show that American Indians in the IHS Oklahoma City Area were hospitalized with RMSF at an annual rate of 48.2 per million population, compared with an estimated hospitalization rate of 16.9 per million Oklahoma residents. The majority of cases in the IHS database (69%) were diagnosed based on clinical suspicion rather than laboratory confirmation. The incidence of RMSF for Oklahoma American Indians as reported to the CDC was 37.4 cases per million, compared with 21.6 per million for all Oklahoma residents (RR 1.7, 95% confidence interval [CI] 1.5, 2.1). CONCLUSIONS: Rates derived from the IHS database may not be comparable to state and national rates because of differences in case inclusion criteria. However, an analysis of case report forms indicates that American Indians n Oklahoma have a significantly higher incidence of RMSF than that of the overall Oklahoma population. Oklahoma American Indians may benefit from educationa campaigns emphasizing prevention of tick bites and exposure to tick habitats.

Kawasaki syndrome among American Indian and Alaska Native children, 1980 through 1995.

BACKGROUND: Kawasaki syndrome (KS) is a leading cause of acquired heart disease among US children, but the epidemiologic features of KS among American Indian and Alaska Native (AI/AN) children have not been described. METHODS: We examined Indian Health Service computerized records of hospital discharges for AI/AN children <18 years of age with KS during 1980 through 1995. RESULTS: During 1980 through 1995, 85 AI/AN children were reported with a hospitalization for KS; 10 of the children had an additional KS hospitalization record within 5 months. The average annual KS hospitalization rate for children <5 years of age, based on first KS hospitalization only, was 4.3 cases per 100000 children; the rate for children age <1 year (n = 21) was 8.6 per 100000 and for children ages 1 to 4 years was 3.6 per 100000. The annual rates for children < 5 years of age ranged from 0 to 8.5 per 100000 children. KS hospitalizations for children peaked in January and February; 50.6% of the children were hospitalized during January through April. The overall median length of hospital stay was 4 days (range, 1 to 29 days); the median duration decreased from 8 days from 1980 through 1982 to 4 days from 1993 through 1995. CONCLUSIONS: The overall annual hospitalization rate of KS among AI/AN children <5 years of age was slightly lower than rates for several majority white populations in the United States. (4.6 to 15.2 cases per 100000) and much lower than rates for blacks and Asians/Pacific Islanders.

Trends in diarrhea-associated hospitalizations among American Indian and Alaska native children, 1980-1995.

OBJECTIVE: To describe trends in diarrhea- associated hospitalizations among American Indian and Alaska Native (AI/AN) children and to estimate the morbidity from rotavirus. DESIGN: Retrospective analysis of Indian Health Service hospital discharge records. PATIENTS: AI/AN children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record. SETTING: Hospitals on or near US Indian reservations from 1980 through 1995. RESULTS: During 1980 through 1995, 21 669 diarrhea-associated hospitalizations were reported among AI/AN children. The annual incidence of diarrhea-associated hospitalizations declined by 76% from 276 per 10 000 in 1980 to 65 per 10 000 in 1995. The median length of hospital stay decreased from 4 days during 1980-1982 to 2 days during 1993-1995. Diarrhea-associated hospitalizations peaked during the winter months (October through March), especially among children 4-35 months of age, with the peaks appearing first in the Southwest during October and moving to the East in March. In the early years of the study (1980-1982), the rate of diarrhea-associated hospitalizations among AI/AN children (236 per 10 000) was greater than the national rate (136 per 10 000). By the end of the study period (1993-1995), the rate for AI/AN children (71 per 10 000) was similar to the national rate (89 per 10 000), although the rate for AI/AN infants remained higher than the national rate for infants. CONCLUSIONS: Diarrhea-associated hospitalization rates for AI/AN children have declined to a level similar to that of the national population. Rotavirus may be an important contributor to diarrheal morbidity among AI/AN children, underscoring the need for vaccines against this pathogen.