Trends in otitis media and myringtomy with tube placement among American Indian/Alaska native children and the US general population of children.

BACKGROUND: Otitis media (OM) morbidity in American Indian and Alaska Native (AI/AN) children is historically higher than that in other US children. METHODS: Outpatient visits and hospitalizations listing OM as a diagnosis and outpatient visits listing myringotomy with insertion of tubes as a procedure among AI/AN children <5 years of age from the Indian Health Service National Patient Information Reporting system for 2003-2005 were analyzed. Outpatient visits and hospitalizations with OM for the general US child population were analyzed using the National Hospital Ambulatory Medical Care and National Ambulatory Medical Care Surveys for 2003-2005, and the 2003 Kids' Inpatient Database, respectively. RESULTS: The OM-associated outpatient visit rate for AI/AN children <5 years of age (89 per 100 children/yr) for 2003-2005 was less than that reported for 1994-1996 (138); however, the rate increased for Alaska region (158 to 181). The OM outpatient visit and myringotomy with insertion of tubes rates (181 and 2.6 per 100 children/yr, respectively) for AI/AN children in Alaska were higher than rates for children in each of the other IHS regions and rates for US children (63 and 1.8 per 100 children/yr, respectively). The OM outpatient visit rates for AI/AN infants (184), especially in the Alaska region (334), were higher than the rate for US infants (84). CONCLUSIONS: The OM-associated outpatient visit rate in AI/AN children <5 years of age has decreased but remains higher than that of the US general child population; however, the rate increased in the Alaska region, where a limited decline in invasive pneumococcal disease has been demonstrated. The ongoing disparity in OM outpatient visit rates among AI/AN children, especially Alaska Native children, indicates a need for new prevention measures, including expanded-valency pneumococcal conjugate vaccines, to reduce OM morbidity.

Pertussis-associated hospitalizations in American Indian and Alaska Native infants.

OBJECTIVE: To investigate the burden of pertussis in American Indian and Alaska Native (AI/AN) infants. STUDY DESIGN: AI/AN pertussis-associated hospitalizations between 1980 and 2004 were evaluated using Indian Health Service (IHS)/tribal inpatient data, which include all reported hospitalizations within the IHS/tribal health care system. RESULTS: Between 1980 and 2004, 483 pertussis-associated hospitalizations in AI/AN infants were documented; 88% of cases involved infants age < 6 months. For this entire period, the average annual hospitalization rate was 132.7 per 100,000 AI/AN infants (95% confidence interval [CI] = 121.3 to 145.2), and 234.5 per 100,000 AI/AN infants age < 6 months (95% CI = 213.1 to 258.1). Between 2000 and 2004, the annual hospitalization rate was 100.5 per 100,000 AI/AN infants (95% CI = 81.6 to 123.7), which exceeds the estimated 2003 pertussis hospitalization rate of 67.7 per 100,000 in the general US infant population (95% CI = 61.9 to 73.5). The highest pertussis hospitalization rates in 2000 to 2004 were in AI/AN infants in the Alaska and Southwestern IHS regions of the United States. CONCLUSIONS: The burden of pertussis in AI/AN infants is high, particularly so in infants age < 6 months in the Alaska and the Southwestern IHS regions of the United States. Ensuring implementation of vaccination strategies to reduce the incidence of pertussis in AI/AN, infants, adolescents, and adults alike is warranted to reduce the burden of pertussis in AI/AN infants.

Epidemiology of hospitalizations associated with ulcers, gastric cancers, and Helicobacter pylori infection among American Indian and Alaska Native persons.

To describe the epidemiology of ulcers, gastric cancer, and Helicobacter pylori infection among American Indian (AI) and Alaska Native (AN) persons, we analyzed hospitalization discharge records with physician discharge diagnoses coded as ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma during 1980 to 2005, and H. pylori during 1996 to 2005 from the Indian Health Service Inpatient Dataset. The average annual age-adjusted rate of hospitalizations that included an ulcer-associated condition was 232.4 per 100,000 AI/AN persons. The age-adjusted rate for gastric cancer was 14.2 per 100,000 persons. MALT lymphoma was listed as a discharge diagnosis at an age-adjusted rate of 6.1 per 100,000, and the age-adjusted rate of H. pylori discharge diagnoses was 28.2 per 100,000. The AI/AN persons living in the Alaska region and those >or= 65 years old had the highest rates of hospitalizations that listed ulcer-associated conditions, gastric cancers, MALT lymphoma, and H. pylori as a discharge diagnosis.

Diarrhea-associated hospitalizations and outpatient visits among American Indian and Alaska Native children younger than five years of age, 2000-2004.

BACKGROUND: Diarrhea accounts for many hospitalizations and outpatient clinic visits among children. American Indian and Alaska Native (AI/AN) children have experienced a greater infectious disease burden compared with the general U.S. population of children, although diarrhea-associated hospitalization rates have declined among AI/AN children. METHODS: Hospital discharge and outpatient visit records with a diagnosis indicating a diarrhea-associated diagnosis were evaluated for AI/AN children <5 years of age, using the 2000-2004 Indian Health Service Direct and Contract Health Service Inpatient Data and outpatient visit data from the Indian Health Service National Patient Information Reporting System, and for the general U.S. population of children <5 years of age using the Kids' Inpatient Database for 2003 and National Ambulatory data for 2000-2004. RESULTS: For 2000-2004, the diarrhea-associated hospitalization rate was similar for AI/AN children and U.S. children <5 years of age (65.9 and 79.3 of 10,000, respectively), but the rate among AI/AN infants was nearly twice the rate among U.S. infants (262.6 and 154.7 of 10,000, respectively). The rate of diarrhea-associated outpatient visits among AI/AN children was higher than for U.S. children (2255.4 versus 1647.9 of 10,000, respectively), as a result of the high rate among AI/AN infants compared with U.S. infants (6103.5 and 2956.3 of 10,000, respectively). CONCLUSIONS: Although the diarrhea-associated hospitalization rate in AI/AN children <5 years old has declined to levels comparable with that of all U.S. children, the rate for AI/AN in infants remains higher than for U.S. infants. The diarrhea-associated outpatient visit rate for AI/AN children was higher than for U.S. children. Ongoing evaluation of hospitalization and outpatient data is important to understand the impact of rotavirus vaccine among AI/AN children.

Asthma hospitalizations among American Indian and Alaska Native people and for the general US population.

STUDY OBJECTIVES: Asthma is one of the most common chronic diseases in the United States. High rates of asthma hospitalization have been reported for some ethnic minorities; however, asthma hospitalization rates for American Indian/Alaska Native (AI/AN) populations of all ages have not been studied. In this study, we examined and compared hospitalization rates for AI/AN populations and the general population in the United States. DESIGN: Hospital discharge records with a first-listed diagnosis of asthma were evaluated for AI/AN populations and the US general population of all ages from 1988 to 2002. RESULTS: The asthma hospitalization rate for AI/AN populations decreased from 17.8/10,000 per year in 1988 to 1990 to 12.9/10,000 per year in 2000 to 2002. The overall age-adjusted rate for 2000 to 2002 was slightly lower than that for the general US population (12.9/10,000 and 16.4/10,000, respectively). However, AI/AN populations living in the Southwest region (17.6/10,000) had the highest asthma hospitalization rate among the Indian Health Service regions and the rate from 2000 to 2002 was similar to that for the general US population. The 2000 to 2002 asthma hospitalization rate for AI/AN populations < 1 year of age (infants) was higher than that in US infants, and the rates for AI/AN age groups > or = 1 year were similar to or lower than those for the general US population. CONCLUSIONS: While asthma was rarely reported among AI/AN populations before 1975, the average annual age-adjusted asthma hospitalization rate was only slightly lower for AI/AN populations than that for the US general population from 2000 to 2002. Furthermore, the asthma hospitalization rates for AI/AN populations living in the Southwest and East regions were similar to the rate for the general US population. Efforts to further increase asthma awareness and symptom recognition among AI/AN populations should be implemented to help to reduce asthma hospitalizations.

Rocky mountain spotted fever hospitalizations among American Indians.

To describe the epidemiology of Rocky Mountain spotted fever (RMSF) among American Indians/Alaska Natives (AI/ANs), we conducted a retrospective analysis of hospitalization records with an RMSF diagnosis using Indian Health Service (IHS) hospital discharge data for calendar years 1980-2003. A total of 261 RMSF hospitalizations were reported among AIs, for an average annual hospitalization rate of 1.21 per 100,000 persons; two deaths were reported (0.8%). Most hospitalizations (88.5%) occurred in the Southern Plains region, where the rate was 4.23 per 100,000 persons. Children 1-4 years of age had the highest age-specific hospitalization rate of 2.50 per 100,000 persons. The overall annual RMSF hospitalization rate declined during the study period. Understanding the epidemiology of RMSF among AI/ANs and educating IHS/tribal physicians on the diagnosis of tick-borne diseases remain important for the prompt treatment of RMSF and the reduction of the disease occurrence among AI/ANs, particularly in high-risk areas.

Infectious disease hospitalizations among older American Indian and Alaska Native adults.

OBJECTIVES: American Indians and Alaska Natives (AI/AN) adults > or = 65 years of age (older adults) have the second highest age group-specific infectious disease (ID) hospitalization rate. To assess morbidity and disparities of IDs for older AI/AN adults, this study examined the epidemiology of overall and specific infectious disease hospitalizations among older AI/AN adults. METHODS: ID hospitalization data for older AI/AN adults were analyzed by using Indian Health Service hospital discharge data for 1990 through 2002 and comparing it with published findings for the general U.S. population of older adults. RESULTS: ID hospitalizations accounted for 23% of all hospitalizations among older AI/AN adults. The average annual ID hospitalization rate increased 5% for 1990-1992 to 2000-2002; however, the rate increased more than 20% in the Alaska and the Southwest regions. The rate for older AI/AN adults living in the Southwest region was greater than that for the older U.S. adult population. For 2000-2002, lower respiratory tract infections accounted for almost half of all ID hospitalizations followed by kidney, urinary tract, and bladder infections, and cellulitis. CONCLUSIONS: The ID hospitalization rate increased among older AI/AN adults living in the Southwest and Alaska regions, and the rate for the older AI/AN adults living in the Southwest region was higher than that for the U.S. general population. Prevention measures should focus on ways to reduce ID hospitalizations among older AI/AN adults, particularly those living in the Southwest and Alaska regions.