Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population

Abstract

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 Novel R848-Conjugated Inactivated Influenza Virus Vaccine Is Efficacious and Safe in a Neonate Nonhuman Primate Model

“…The rate of LRTI-associated hospitalizations is >4 times higher in children less than 1 year of age compared to those between 1 and 4 years (1) and infants younger than 6 months of age are particularly vulnerable to the development of severe disease (2). Not surprisingly then, the highest risk of death occurs in the first years of life (2).…”

Impact of home remediation and household education on indoor air quality, respiratory visits and symptoms in Alaska Native children

“…Longitudinal studies show that childhood pneumonia is associated with asthma, and with impaired lung function, which persists into adulthood [21]. The study region has one of the highest LRTI hospitalisation rates in the US [1,22], with median cost of LRTI hospitalisation for respiratory syncytial virus estimated at $22,323 [23]. One out of 63 children in this region develop a chronic lung condition, bronchiectasis, from severe or repeated pneumonias, which can lead to increased morbidity in adulthood [2,24].…”

“…Alaska Native children living in rural southwest Alaska experience some of the highest reported rates of hospitalisation from lower respiratory tract infections (LRTIs) [1]. The pneumonia hospitalisation rate for infants from Alaska’s southwest Yukon Kuskokwim (YK) Delta region is tenfold higher than for other US infants [1].…”

“…The pneumonia hospitalisation rate for infants from Alaska’s southwest Yukon Kuskokwim (YK) Delta region is tenfold higher than for other US infants [1]. Bronchiectasis, a chronic lung sequelae of early and severe pneumonia, has nearly disappeared from the developed world, but is still frequently seen among southwest Alaska Native children [2,3].…”

Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada

“…Population-based studies in the US and Australia have shown substantially higher rates of hospital admissions (an indicator of severe infant morbidities) in Indigenous than in non-Indigenous infants. [8][9][10][11][12][13][14] Likewise, we would expect substantial disparities in Indigenous versus non-Indigenous infant hospitalizations in Canada. Indigenous infants in Canada often live in communities with poor access to high-quality care, and in communities and families with poor socioeconomic conditions that are strongly predictive of poor infant health.…”