Trends in Hospitalization of American Indian and Alaska Native Children Under Age 5, United States, 1999-2009
METHODS: We calculated hospitalization rates per 100,000 population <5 year of age, based on first-listed discharge diagnosis during 2001–2011 using the Indian Health Service National Patient Information Reporting System for AI/AN children and using the Agency for Healthcare Research and Quality Kids Inpatient Database for US children.
RESULTS: The all-cause and ID annual rates in the US in 2009 were 25,510 (95% CI, 24,661.6–26,358.2) and 2,403 (95% CI, 2,253.4–2,553.4), and the average annual rates in AI/AN in 2008–2010 were 12,266 and 2,622 (overall) and 23,735 and 5,031 (Alaska). From 2001–2011, the all-cause annual rate in AI/AN decreased 22% overall to 11,374.62 and increased 7% in Alaska to 22,513.23, and the ID annual rate in AI/AN decreased 32% overall to 2,230.45 and decreased 2% in Alaska to 4,550.26. The top all-cause hospitalization reasons in AI/AN were conditions originating in the perinatal period (67.0%) and respiratory diseases (20.2%), and the top ID hospitalization reasons were respiratory (71.7% lower and 6.0% upper), skin/cellulitis (5.3%), and genitourinary (4.1%).
CONCLUSIONS: AI/AN children had a higher ID hospitalization rate, and a lower all-cause rate, than US children. Alaska AI/AN children had a much higher ID hospitalization rate, and a lower all-cause rate, than US children. All-cause and ID hospitalization rates for AI/AN children decreased substantially during 2001–2011, but these improvements were not seen in Alaska. The most common ID hospitalization reasons in AI/AN children were lower/upper respiratory, skin/cellulitis and genitourinary, which are associated with poor access to sanitation and overall health status. Prevention strategies for this group should focus on high-risk regions and illnesses contributing to health disparities.