AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.
BackgroundThe lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998–2008, yet remained 1.6 times higher than the general US child population in 2006–2008.PurposeDescribe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years.MethodsA retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009–2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998–1999 rates prior to pneumococcal conjugate vaccine introduction.ResultsThe average annual LRTI-associated hospitalization rate declined from 1998–1999 to 2009–2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009–2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6–14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009–2010 H1N1 influenza-associated hospitalizations.ConclusionsAlthough the LRTI-associated hospitalization rate declined, the 2009–2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.
A coordinated, multidisciplinary effort involving federal, state, local, and tribal health officials is needed to address this important public health issue.
Background
Rickets and vitamin D deficiency appeared to increase in Alaskan children, starting in the 1990s. We evaluated the epidemiology of rickets and vitamin D deficiency in Alaska Native (AN) children in 2001-2010.
Methods
We analyzed 2001-2010 visits with rickets or vitamin D deficiency diagnosis for AN and American Indian children and the general U.S. population aged <10 years. We conducted a case-control study of AN rickets/vitamin D deficient cases and age- and region-matched controls.
Results
AN children annual rickets-associated hospitalization rate (2.23/100,000 children/year) was higher than general U.S. rate (1.23; 95% CI 1.08-1.39). Rickets incidence increased with latitude. Rickets/vitamin D deficiency cases were more likely to have malnutrition (OR 38.1; 95% CI 4.9-294), had similar breastfeeding prevalence, and were less likely to have received vitamin D supplementation (OR 0.23; 95% CI 0.1-0.87), than controls.
Conclusions
Our findings highlight the importance of latitude, malnutrition and lack of vitamin D supplementation as risk factors for rickets.
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