Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State

Abstract

Background The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population. Methods We performed probabilistic record linkage between the Washington Trauma Registry (2005–2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality. Results Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, p<0.001) and more commonly male (66.5% vs 61.2%, p<0.001). AI/AN experienced more intentional injuries (suicide or homicide: 20.1% vs 6.7%, p<0.001), a higher proportion of severe traumatic brain injury (20.7% vs 16.8%, p=0.004) and were less likely than caucasians to use safety equipment such as seat belts/airbags (53.9% vs 76.7%, p<0.001). ISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58). Conclusions Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide.

Assessment of Racial Misclassification Among American Indian and Alaska Native Identity in Cancer Surveillance Data in the United States and Considerations for Oral Health: A Systematic Review

“…A total of 27 of the 66 (2%) articles met the criteria for the Dissemination domain. 5 , 7 , 33 , 40 , 41 , 47 , 49 , 51 , 53 , 56 , 60 , 61 , 67–69 , 73–76 , 78 , 85 , 86 , 88–90 , 97 , 98 These articles stated the relevance of the findings to relevant Indigenous governing bodies and peoples and/or implementation strategies. A total of 9 of the 66 (1.5%) articles met the criteria for the Participation domain.…”

“… 95 , 98 There were 10 (18%) articles that solely analyzed AI/AN populations and did not compare any other racial or ethnic group. 33 , 39 , 47 , 53 , 60 , 61 , 63 , 86 , 87 , 89 The most common method of addressing racial misclassification among these articles was linkage with the IHS or tribal clinic records (45 articles or 82%), linkage with tribal registries (4 articles or 7%), or tribal rolls (1 article or 2%). Two of the remaining five articles limited their analysis to counties served by the IHS and counties adjacent to reservation or Indian lands, 45 , 52 also known as Purchased/Referred Care Delivery Area (PRCDA), historically referenced as Contract Health Service Delivery Areas.…”

Social Determinants of Traumatic Brain Injury in the North American Indigenous Population: A Review

“…All-cause trauma is a major contributor to death within the indigenous populations of North America. 18 Population-wide studies of mortality indicate that indigenous people have the highest mortality rate within the following demographic categories: race/ethnicity, falls, and MVAs. 3 Similarly, Dudley et al 12 discuss the indigenous population of Quebec reported a rate of TBI of four times the general Canadian population.…”

Assessing New Diagnoses of HIV Among American Indian/Alaska Natives Served by the Indian Health Service, 2005-2014

“…leading to an underestimation of the burden of disease. [3][4][5][6] A large subset of the AI/AN population is served by the Indian Health Service (IHS), an integrated national health care delivery system of primarily rural clinics and hospitals. The IHS serves an estimated 2.2 million AI/ANs.…”

“…2 However, because of a lack of complete and accurate data on race/ethnicity in national surveillance and vital statistics systems, it is often difficult to accurately assess the health status for this population, as AI/ANs are more likely to be misclassified as another race than are people from other racial/ethnic minority groups, leading to an underestimation of the burden of disease. 3 -6 A large subset of the AI/AN population is served by the Indian Health Service (IHS), an integrated national health care delivery system of primarily rural clinics and hospitals. The IHS serves an estimated 2.2 million AI/ANs.…”