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

Abstract

Background: The 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.

Purpose: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years.

Methods: A 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.

Results: The 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.

Conclusions: Although 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.

Keywords: Alaska Native; American Indian; epidemiology; pneumonia; respiratory.

Fig. 1

Average annual hospitalization rates associated with lower respiratory tract infection (LRTI) by disease category (any pneumonia, bronchiolitis without pneumonia and other LRTI diagnoses) among American Indian/Alaska Native (AI/AN) children and among the general US child population <5 years of age, by age group, 2009–2011. Data from the IHS National Patient Information Reporting System (7) for AI/AN children and the Nationwide Inpatient Sample for the general US child population (8).

Fig. 2

Annual hospitalization rates associated with lower respiratory tract infection (LRTI), bronchiolitis, pneumonia, respiratory syncytial virus (RSV) and influenza among American Indian and Alaska Native (AI/AN) children and among the general US child population <5 years by age group, 1998–2011. Data from IHS National Patient Information Reporting System (7) for AI/AN children and the Nationwide Inpatient Sample for the general US child population (8).