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Diarrhea-Associated Hospitalizations and Outpatient Visits Among American Indian and Alaska Native Children Younger Than Five Years of Age, 20002004

Singleton, Rosalyn J. MD, MPH*†; Holman, Robert C. MS‡; Yorita, Krista L. MPH‡; Holve, Steve MD§; Paisano, Edna L. MSW∥; Steiner, Claudia A. MD, MPH¶; Glass, Roger I. MD, PhD#; Cheek, James E. MD, MPH**

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181256595
Original Studies
Abstract

Background: Diarrhea accounts for many hospitalizations and outpatient clinic visits among children. American Indian and Alaska Native (AI/AN) children have experienced a greater infectious disease burden compared with the general U.S. population of children, although diarrhea-associated hospitalization rates have declined among AI/AN children.

Methods: Hospital discharge and outpatient visit records with a diagnosis indicating a diarrhea-associated diagnosis were evaluated for AI/AN children <5 years of age, using the 2000–2004 Indian Health Service Direct and Contract Health Service Inpatient Data and outpatient visit data from the Indian Health Service National Patient Information Reporting System, and for the general U.S. population of children <5 years of age using the Kids’ Inpatient Database for 2003 and National Ambulatory data for 2000–2004.

Results: For 2000–2004, the diarrhea-associated hospitalization rate was similar for AI/AN children and U.S. children <5 years of age (65.9 and 79.3 of 10,000, respectively), but the rate among AI/AN infants was nearly twice the rate among U.S. infants (262.6 and 154.7 of 10,000, respectively). The rate of diarrhea-associated outpatient visits among AI/AN children was higher than for U.S. children (2255.4 versus 1647.9 of 10,000, respectively), as a result of the high rate among AI/AN infants compared with U.S. infants (6103.5 and 2956.3 of 10,000, respectively).

Conclusions: Although the diarrhea-associated hospitalization rate in AI/AN children <5 years old has declined to levels comparable with that of all U.S. children, the rate for AI/AN in infants remains higher than for U.S. infants. The diarrhea-associated outpatient visit rate for AI/AN children was higher than for U.S. children. Ongoing evaluation of hospitalization and outpatient data is important to understand the impact of rotavirus vaccine among AI/AN children.

Author Information

From the *Alaska Native Tribal Health Consortium, Anchorage, AK; †Arctic Investigations Program, Coordinating Center for Infectious Diseases (CCID), Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (USDHHS), Anchorage, AK; ‡Division of Viral and Rickettsial Diseases, CCID, CDC, USDHHS, Atlanta, GA; §Pediatric Unit, Tuba City Regional Health Corporation, Tuba City, AZ; ∥Division of Program Statistics, Office of Public Health Support (OPHS), Indian Health Service, and ¶Healthcare Cost and Utilization Project, Center for Delivery, Organizations and Markets, Agency for Healthcare Research and Quality, USDHHS, Rockville, MD; #Fogarty International Center, National Institutes of Health, Bethesda, MD; and **Division of Epidemiology, OPHS, IHS, USDHHS, Albuquerque, NM.

Accepted for publication May 24, 2007.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agencies.

Address for correspondence: Rosalyn Singleton, MD, MPH, AIP-CDC, 4055 Tudor Centre Dr., Anchorage, AK 99508. E-mail: ris2@cdc.gov.

© 2007 Lippincott Williams & Wilkins, Inc.