Disparities in Outcomes During Lower Respiratory Tract Infection in American Indian Children

Abstract

Background: American Indian (AI) children are at increased risk for severe disease during lower respiratory tract infection (LRTI). The reasons for this increased severity are poorly understood. The objective of this study was to define the clinical presentations of LRTI and highlight the differences between AI and non-AI previously healthy patients under the age of 24 months. Methods: We performed a retrospective chart review between October 2010 and December 2019. We reviewed 1245 patient charts and 691 children met inclusion criteria for this study. Data records included demographics, clinical, laboratory data, and illness outcomes. Results: Of 691 patients, 120 were AI and 571 were non-AI. There was a significant difference in breast-feeding history (10% of AI vs. 28% of non-AI, P < 0.0001) and in secondhand smoke exposure (37% of AI vs. 21% of non-AI, P < 0.0001). AI children had increased length of hospitalization compared with non-AI children (median of 3 vs. 2 days, P < 0.001). In addition, AI children had higher rates of pediatric intensive unit admission (30%, n = 37) compared with non-AI children (11%; n = 67, P < 0.01). AI children also had higher rates (62.5%, n = 75) and duration of oxygen supplementation (median 3 days) than non-AI children (48%, n = 274, P = 0.004; median 2 days, P = 0.0002). On a multivariate analysis, AI race was an independent predictor of severe disease during LRTI. Conclusions: AI children have increased disease severity during LRTI with longer duration of hospitalization and oxygen supplementation, a higher rate of oxygen requirement and Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation pediatric intensive care unit admissions, and a greater need for mechanical ventilation. These results emphasize the need for improvement in health policies and access to health care in this vulnerable population.

Impact of climate change on paediatric respiratory health: pollutants and aeroallergens

“…In Sub-Saharan Africa, children in rural areas face a higher risk of acute respiratory infections, particularly linked with factors such as small or large size at birth, not receiving vitamin A supplements, being severely underweight, and being aged 36–59 months [ 154 ]. A study in rural South Dakota revealed that Native American children with lower respiratory tract infections suffer from increased disease severity, requiring longer hospital stays and more intensive treatments, including oxygen supplementation and mechanical ventilation [ 155 ].…”

The Moby Bookmobile: Providing Health Education Materials in Wyoming Indian Country

“…One specific issue the Moby Bookmobile was designed to address was the inability for the community to access tribal public and school libraries, creating an opportunity to provide reading materials to the populations served on the Wind River Indian Reservation. Adding culturally relevant health-related books and materials to the bookmobile collection was an attempt to address the well-documented issue of rural Native American populations having a number of health-related disparities and issues (Findling et al, 2022; Kills First et al, 2022; Palmer et al, 2022; Zahnd et al, 2022). For this reason, the Moby Bookmobile sought and received funding from the NNLM Region 4, to increase access to health education books and other health-related materials to be distributed to the Wind River Reservation Communities.…”