Disparities in Infectious Disease Hospitalizations for American Indian/Alaska Native People

Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, 1600 Clifton Rd. NE, MS A-39, Atlanta, GA 30333, USA.
Public Health Reports (Impact Factor: 1.55). 07/2011; 126(4):508-21. DOI: 10.2307/41639393
Source: PubMed


We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (AI/AN) people.
We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998-2006 for AI/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey.
The ID hospitalization rate for AI/AN people declined during the study period. The 2004-2006 mean annual age-adjusted ID hospitalization rate for AI/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for AI/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all AI/AN hospitalizations. Lower-respiratory-tract infections accounted for the largest proportion of ID hospitalizations among AI/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%).
Although the ID hospitalization rate for AI/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities.

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    • "Given this gap in the profession's knowledge base, the present study sought to identify predictors of satisfactorily addressing spiritual needs among hospitalized AIs. Hospitals are a particularly important health care venue since AI health disparities often mean that members of this population are disproportionately hospitalized (Holman et al., 2011). Identifying predictors of satisfaction in such settings can help practitioners provide more effective services by isolating those variables that impact service delivery (Chandra et al., 2011). "
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    ABSTRACT: Spirituality is instrumental to health and wellness in many American Indian (AI) cultures. Although the Joint Commission requires spiritual assessments to identify and address clients' spiritual needs during hospitalization, little is known about the operationalization of this process for American Indians (AIs). To address this gap in the literature, the present study employed a national sample of AIs (N = 1,281) to identify predictors of satisfaction with the manner in which their spiritual needs were addressed. The results suggest the discharge process, physicians, room quality, and nurses play important roles in satisfactorily addressing AIs' spiritual needs. Of these, the discharge process had the largest effect on satisfaction, underscoring the salience of social workers in addressing the spiritual needs of hospitalized AIs.
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    • "A high rate of ID hospitalisations has been reported in the AI/AN population in Alaska (2–4, 6–8, 10), and the overall infant ID hospitalisation rate in the IHS Alaska region has been reported higher than that for all other IHS regions and the general US population (2, 3). Respiratory disease has been implicated as a major health problem in the AN population, especially among young children (10, 12–17) . "
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    ABSTRACT: To examine the epidemiology of infectious disease (ID) hospitalisations among Alaska Native (AN) people. Hospitalisations with a first-listed ID diagnosis for American Indians and ANs residing in Alaska during 2001-2009 were selected from the Indian Health Service direct and contract health service inpatient data. ID hospitalisations to describe the general US population were selected from the Nationwide Inpatient Sample. Annual and average annual (2007-2009) hospitalization rates were calculated. During 2007-2009, IDs accounted for 20% of hospitalisations among AN people. The 2007-2009 average annual age-adjusted ID hospitalisation rate (2126/100,000 persons) was higher than that for the general US population (1679/100,000; 95% CI 1639-1720). The ID hospitalisation rate for AN people increased from 2001 to 2009 (17%, p<0.001). Although the rate during 2001-2009 declined for AN infants (<1 year of age; p=0.03), they had the highest 2007-2009 average annual rate (15106/100,000), which was 3 times the rate for general US infants (5215/100,000; 95% CI 4783-5647). The annual rates for the age groups 1-4, 5-19, 40-49, 50-59 and 70-79 years increased (p<0.05). The highest 2007-2009 age-adjusted average annual ID hospitalisation rates were in the Yukon-Kuskokwim (YK) (3492/100,000) and Kotzebue (3433/100,000) regions; infant rates were 30422/100,000 and 26698/100,000 in these regions, respectively. During 2007-2009, lower respiratory tract infections accounted for 39% of all ID hospitalisations and approximately 50% of ID hospitalisations in YK, Kotzebue and Norton Sound, and 74% of infant ID hospitalisations. The ID hospitalisation rate increased for AN people overall. The rate for AN people remained higher than that for the general US population, particularly in infants and in the YK and Kotzebue regions. Prevention measures to reduce ID morbidity among AN people should be increased in high-risk regions and for diseases with high hospitalisation rates.
    Full-text · Article · Aug 2013
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    • "This is likely the first study to develop and test a model of spiritual care for older hospitalized American Indians with a national sample of Native patients. Members of this population can experience disproportionate levels of hospitalization and frequently have culturally unique spiritual needs (Gone & Trimble, 2012; Holman et al., 2011 "
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    ABSTRACT: Purpose: Although spirituality is typically intertwined with health in Native cultures, little research has examined the relationship between American Indians' spiritual needs and overall satisfaction with service provision during hospitalization. This study examined this relationship, in tandem with the effects of 8 potential mediators, to develop a model of spiritual care for older hospitalized American Indians. Design and methods: Structural equation modeling was used with a sample of American Indians (N = 860), aged 50 and older, who were consecutively discharged from hospitals across the United States over a 12-month period. Results: As posited, addressing spiritual needs was positively associated with overall satisfaction with service provision. The relationship between spiritual needs and satisfaction was fully mediated by 4 variables: nursing staff, the discharge process, physicians, and visitors. Implications: As the first study to develop and test a model of spiritual care for older hospitalized American Indians, this study provides practitioners with the information to provide more effective, culturally relevant services to older American Indians.
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