Motor-vehicle crash-injury risk factors among American Indians

Non-Obstetric Maternal Mortality Trends by Race in the United States

OBJECTIVES

Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US).

METHODS

A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models.

RESULTS

From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90-2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13-1.17) and American Indian women (1.17, 1.13-1.21).

CONCLUSION

Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes.

AMERICAN INDIAN AND ALASKA NATIVE BOYS: EARLY CHILDHOOD RISK AND RESILIENCE AMIDST CONTEXT AND CULTURE

American Indian and Alaska Native (AIAN) adolescent and adult men experience a range of health disparities relative to their non-AIAN counterparts and AIAN women. Given the relatively limited literature on early development in tribal contexts, however, indicators of risk during early childhood specific to AIAN boys are not well-known. The current article reviews sources of strength and challenge within AIAN communities for AIAN children in general, including cultural beliefs and practices that support development, and contextual challenges related to socioeconomic and health disparities and historical trauma affecting the AIAN population as a whole. The research literature on early development is reviewed, highlighting what this literature reveals about early gender differences. The article concludes with calls to action on behalf of AIAN boys that align with each of the five tiers of R. Frieden's (2010) Public Health Pyramid.

No Disparity for American Indians in Surgery for Pelvis/Lower Extremity Fractures: a Cohort Study of the National Trauma Data Bank (NTDB)

BACKGROUND

Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx).

METHODS

Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses.

RESULTS

AI/AN patients (2.7 %, n = 206) were younger (36 ± 16 versus 41 ± 18 years, p < 0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7 ± 25.3 versus 12.0 ± 22.5 h, respectively). Injury severity was predictive of surgery in all six models (OR = 0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (OR = 3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time.

CONCLUSION

The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx.

American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009

OBJECTIVES

We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death.

METHODS

We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties.

RESULTS

The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths.

CONCLUSIONS

Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable.

Crash risk factors related to individuals sustaining and drivers following traumatic brain injuries

OBJECTIVE

Some crashes result in drivers experiencing (or sustaining) a traumatic brain injury (TBI) while other crashes involve drivers that have already experienced a TBI. The objective of this study is to examine the factors that influence these two TBI crash groups.

METHODS

Data from the Iowa Department of Public Health's Brain Injury Registry and Department of Transportation's crash records were linked together and used in logistic regression models to predict the likelihood of a driver sustaining a TBI in a crash and those who drive after a TBI.

RESULTS

Between 2001 and 2006, there were 2382 crashes in which an individual sustained a TBI. As expected, a higher likelihood of sustaining a TBI was observed for motorcycle drivers who did not wear a helmet and in crashes that resulted in total or disabling vehicle damage. Focusing specifically on the post-TBI drivers (and not occupants), 1583 were involved in crashes. These post-TBI drivers were less likely to wear seatbelts or have passengers in the vehicle at the time of the crash, and were more likely to crash at night. Post-TBI drivers were also involved in significantly more multiple crashes (about 14%) when compared to drivers who have not experienced a TBI (about 10%) during the study period. When controlling for gender, date of injury, and severity of TBI (using Glasgow Coma Scale), individuals that sustained a TBI when they were younger were more likely to be involved in multiple crashes.

CONCLUSIONS

Different factors influence the crash likelihood for those that sustain a TBI in a crash and those that crash following a TBI. In general, post-TBI drivers have a higher occurrence of multiple crashes and this should be further explored to guide driver rehabilitation, evaluation, and training.

Understanding high-risk behavior among non-dominant minorities: a social resistance framework

Across different societies, non-dominant minority groups, compared to the dominant group, often exhibit higher rates of involvement in high-risk behaviors, such as smoking, drug and alcohol use, sexual risk behaviors, overeating, and unsafe driving habits. In turn, these behaviors have a well-documented impact on chronic disease, morbidity, and mortality. Previous studies have emphasized macro-structural or micro-agentic explanations for this phenomenon. Such explanations suffer from mirror-image shortcomings, such as, by emphasizing structural barriers, macro-level explanations leave out individual agency ("the over-socialized conception of the individual"), while micro-level theories give short shrift to structural constraints that prevent individuals from engaging in health-promoting behaviors ("the under-socialized conception of the individual"). Moreover, most current theories regard individuals as passive players who are influenced by the social environment or by psychological problems, or who make "bad" choices. The current paper develops an integrated theoretical framework that incorporates structural inequalities while leaving intact the role of individual agency. According to the social resistance framework, power relations in society encourage members of non-dominant minority groups to actively engage in everyday resistance practices that include various unhealthy behaviors. The paper develops propositions from which testable hypotheses can be generated, and discusses the implications and contributions of the social resistance framework.

Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the reservation

OBJECTIVES

American Indians (AI's) have the lowest rate of seatbelt use in the nation, putting them at significant risk for motor vehicle crash (MVC) morbidity and mortality. This study compares seatbelt use in victims of level one trauma crashes presenting from on and off AI reservations. Predictors of seatbelt use were evaluated as well. We hypothesized that AI's in crashes on a reservation would have lower rates of seatbelt use, even compared to AI's in crashes from off the reservation.

METHODS

This is a retrospective cohort study of consecutive MVC victims presenting to a level one trauma facility in Phoenix, Arizona from July 2003 to June 2005. Inclusion criteria were age >11 and transported directly from the crash; struck pedestrians were excluded. Inter-facility transports were also excluded, as these patients would likely represent a sicker population, possibly introducing bias. Characteristics of those patients (sex, race, location of crash, alcohol and seatbelt use) were analyzed in univariate and multivariate logistic regression.

RESULTS

Data were collected on 2339 patients. Three hundred ninety-two were excluded, leaving 1947 (83%) available for analysis. AI's had lower rates of seatbelt use compared to all other races. Additionally, AI's on a reservation were less likely to wear seatbelts than those off a reservation (25.9% versus 42.7%). However, when tested in a multivariate analysis with alcohol as a covariate, race and location became insignificant. Low seatbelt use by AI's on the reservation was primarily associated with alcohol use.

CONCLUSION

In this analysis, alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility. If we assume unbelted passengers are more severely injured, this would bias our results. The application of these data may help direct future public service efforts to increase seatbelt use in target populations.

Seat belt use among American Indians/Alaska Natives and non-Hispanic whites

BACKGROUND

Accidents (including motor vehicle injuries) are a leading cause of death among American Indians/Alaskan Natives (AI/AN). The purpose of this study was to examine geographic variation and the existence of a seat belt law on seat belt use among AI/AN and non-Hispanic whites (NHW).

METHODS

Self-reported seat belt behavior data from the 1997 and 2002 Behavioral Risk Factor Surveillance System were analyzed in 2006-2007 and were restricted to AI/AN (n=4,310 for 2002, and n=1,758 for 1997) and NHW (n=193,617 for 2002, and n=108,551 for 1997) aged 18 years and older.

RESULTS

Seat belt non-use varied significantly across geographic regions for both AI/AN and NHW. For example, AI/AN living in the Northern Plains (odds ratio [OR]=12.4, 95% confidence interval [CI]=6.5-23.7) and Alaska (OR=10.3, 95%CI=5.3-19.9) had significantly higher seat belt non-use compared to AI/AN living in the West. In addition, compared to those residing in urban areas, those living in rural areas were 60% more likely in NHW and 2.6 times more likely in AI/AN not to wear a seat belt. Both AI/AN and NHW living in states without primary seat belt laws were approximately twice as likely to report seat belt non-use in 2002 as those living in states with primary laws. In states with primary laws enacted between 1997 and 2002, AI/AN experienced greater decline in seat belt non-use than NHW.

CONCLUSIONS

Seat belt use among AI/AN and NHW varied significantly by region and urban-rural residency in 2002. Primary seat belt laws appear to help reduce regional and racial disparities in seat belt non-use.

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES

To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated.

METHODS

An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk.

RESULTS

Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5).

CONCLUSION

The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.

Injury mortality among ethnic minority groups in the Netherlands

OBJECTIVES

To prepare a comprehensive overview of ethnic differences in injury related mortality in the Netherlands and to determine the role of area income and urbanisation degree.

METHODS

Data for the period 1995-2000 were obtained from the population and cause of death registries. Injury related death rates were compared for persons from Turkish, Moroccans, Surinamese, and Antillean/Aruban origin with rates for the native Dutch population.

RESULTS

Compared with the native Dutch population, all ethnic minorities combined had an increased mortality for all injuries together (RR = 1.29). Ethnic minorities experienced a significantly higher risk of death from pedestrian accidents (RR = 1.87), drowning (RR = 2.58), poisoning (RR = 1.76), fire and scalds (RR = 1.95), and homicide (RR = 3.24). Mortality for cyclists (RR = 0.53) and motorcycle drivers (RR = 0.47) was significantly lower among ethnic minorities compared with the native Dutch. Adjustment for area income and urbanisation decreased the mortality risk difference for most of the non-traffic injuries, but showed a difference in risk for car driver and passenger accidents (RR = 1.37). Compared with the native Dutch inhabitants, Surinamese and Antillean/Aruban population had a higher risk of total injury mortality (RR = 1.33 and 1.53 respectively), while Turkish and Moroccans had increased risk only for selected conditions. Inequalities in injury mortality were the highest among children and young adults, but persisted in the age group above 50 years old.

CONCLUSION

Ethnic differences in injury mortality in the Netherlands strongly depended on type of injury, ethnic group, sex, and age. Policies should be aimed at the prevention of high risk injuries among the most vulnerable ages and ethnic groups.

Language, income, education, and alcohol-related fatal motor vehicle crashes

This paper investigates the role of race/ethnicity, language skills (a proxy for acculturation among Hispanics in Arizona, California, New Mexico, and Texas), income, and education level on alcohol-related fatal motor vehicle crashes. Using the Fatality Analysis Reporting System (FARS), we confirmed previous state-based studies showing that high income and education levels have a protective influence on alcohol-related fatal motor vehicle crashes. We also confirmed that language proficiency/acculturation tends to increase the vulnerability of Hispanic women to alcohol-related fatalities. Differences in alcohol-related fatality rates across Hispanic subgroups are observed. Future reductions in alcohol-related traffic fatalities may require prevention policies that take into account existent variations in acculturation, income, and education among racial/ethnic groups and subgroups.

Stop sign violations: the role of race and ethnicity on fatal crashes

INTRODUCTION

In contrast to age, education, and gender, which have been studied more frequently, the role of race/ethnicity in shaping fatal stop sign running incidents has received relatively little attention. It has been shown that failing to follow traffic laws and regulations is a major cause of motor vehicle crashes (MVCs) in Latin America. Does this driving behavior in Latin America correspond to the Hispanic community in the United States? Are Hispanics more likely to be at-fault concerning stop sign crossing than other racial/ethnic groups in the United States?

METHOD

We took advantage of a 1990-1996 Fatality Analysis Reporting System (FARS) file with additional racial/ethnic information. Our file consisted of drivers who died in a MVC that occurred in an intersection where a stop sign was in place that involved one or more drivers with at least one of them failing to obey the traffic device. Descriptive statistics and logistic regressions were applied.

RESULTS

Overall, we found no direct difference between African-American, White, and Hispanic drivers regarding stop sign running. However, we found that race/ethnicity does play an indirect role on this problem through its impact on drinking and driving as well as its interaction with age and gender.

CONCLUSIONS

We found a picture that is much more complex than what the initial hypothesis postulated. Race/ethnicity seems to play a role in shaping fatal stop sign running incidents, but the mechanisms by which such a role is played are complex and not fully understood.

IMPACT ON INDUSTRY

The incidence and cost of fatal stop sign running crashes may be reduced if prevention policies targeting the most vulnerable groups could be developed.

Fatal red light crashes: the role of race and ethnicity

There is an increasing number of motor vehicle crashes (MVCs) in the U.S. that occur at intersections. Noncompliance with traffic signals is one of the causes for such increase. In this study, we focused on Hispanic drivers. It has been shown that failing to follow traffic laws and regulations is a major cause of MVCs in Latin America. Does this driving behavior in Latin America correspond to the Hispanic community in the U.S.? Are U.S. Hispanics more likely to die in a red light incident? Are Hispanics more likely to be red light runners than other racial/ethnic groups in the U.S.? We answered these questions by taking advantage of a 1990-1996 Fatality Analysis Reporting System (FARS) file with additional racial/ethnic information. Overall, we found no differences between African-American, White, and Hispanic drivers regarding red light running. We found that drinking and driving was the most important factor for red light running. However, we found evidence that some Hispanic subgroups may be more vulnerable to red light running. One such subgroup is formed by Hispanics who have no valid driver license and no record of previous driver license suspension. This study is the first to apply national, archival data to document the relevance of race/ethnicity to the red light running problem, and we hope that it might serve as an incentive for more research on this area.

Population characteristics of traffic accident-related deaths in Japan and Ireland, 1950-2000

To compare epidemiological characteristics of traffic accidents in Japan and Ireland, we analyzed mortality and the negative effect on life expectancy between 1950 and 2000 and generated a multivariate model. The characteristics were similar in the two countries: The time trends showed an increase in mortality followed by a decrease. The mortality rates were about 13 and 5/100,000 for males and females, respectively, in 2000. Correlation coefficients for sex were over 0.9. Age distribution obeyed the natural logarithm regularity. The negative effect on life expectancy was about 0.34 year for males, and 0.13 year for females. The economic level was positively associated with mortality, whereas "number of vehicles owned" was associated negatively. In conclusion, we can take advantage of the broad consistencies in these two countries when we draw up an intervention strategy. Any preventive strategy should be directed to the young, particularly males.

Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96

OBJECTIVE

To compare rates of motor vehicle crash (MVC) fatalities among different race/ethnic groups in urban and rural Arizona.

METHOD

Using the Fatality Analysis Reporting System and the National Center for Health Statistics Multiple Cause of Death file, MVC fatalities in Arizona from 1990-96 inclusive were classified by gender, race/ethnicity, and urban or rural residence. Age adjusted rates of total, occupant, pedestrian, and alcohol related fatalities were calculated. The total MVC fatality rate for each race/ethnic group was then adjusted for proportion of rural residence.

RESULTS

Compared with non-Hispanic whites (NHWs), American Indians had raised relative risks for MVC fatality in all gender and residence subgroups. Hispanic females and rural Hispanic males had lower relative risks, as did rural African-American men. Raised relative risks for American Indian men and women included all subgroups: total, occupant, pedestrian, and alcohol related. Hispanic and African-American men both had raised relative risks of pedestrian related fatalities, and Hispanic men had a slightly higher relative risk while Hispanic women had a lower relative risks, for alcohol related fatality. Hispanic men and women and African-American men had lower occupant fatality rates. Close to half (45%) of the excess MVC fatality among American Indians can be attributed to residence in rural areas, where MVC fatality rates are higher. There were 1.85 occupants in crashes involving NHW deaths compared with 2.51 for Hispanics and 2.71 for American Indians (p<0.001). The proportion of occupants not using a seatbelt was higher in Hispanics and American Indians in both urban and rural areas.

CONCLUSION

The major disparity in MVC fatality in Arizona is among American Indians. The higher MVC fatality rates among American Indians occur in all age groups, in both urban and rural areas, and among occupants and pedestrians. Rural residence, lower rates of seatbelt use, higher rates of alcohol related crashes, a greater number of occupants, and higher rates of pedestrian deaths all contribute to the American Indian MVC fatality disparity. High rates of pedestrian fatality occur in men in all three race/ethnic minorities in Arizona and among American Indian women. In contrast to other studies, African-Americans and Hispanics did not have raised total MVC fatality rates and compared to NHWs actually had lower rates in the rural areas of the state.

Pediatric motor vehicle related injuries in the Navajo Nation: the impact of the 1988 child occupant restraint laws

BACKGROUND

Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law.

OBJECTIVE

Assess the impact of the laws on the rate and severity of pediatric (0-19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation.

METHODS

Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810-825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983-88, were compared with those after enactment and enforcement, 1991-95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and chi(2) tests were used for analysis.

RESULTS

Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0-4 years (62 (7) to 28 (4)), 5-11 years (55.3 (6) to 26 (4)), and 15-19 years (139 (14) to 68 (7)); p=0.0001. In children 0-4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0-4 year age group (p=0.03).

CONCLUSIONS

Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children.

The prevention of unintentional injury among American Indian and Alaska Native children: a subject review. Committee on Native American Child Health and Committee on Injury and Poison Prevention. American Academy of Pediatrics

Among ethnic groups in the United States, American Indian and Alaska Native (AI/AN) children experience the highest rates of injury mortality and morbidity. Injury mortality rates for AI/AN children have decreased during the past quarter century, but remain almost double the rate for all children in the United States. The Indian Health Service (IHS), the federal agency with the primary responsibility for the health care of AI/AN people, has sponsored an internationally recognized injury prevention program designed to reduce the risk of injury death by addressing community-specific risk factors. Model programs developed by the IHS and tribal governments have led to successful outcomes in motor vehicle occupant safety, drowning prevention, and fire safety. Injury prevention programs in tribal communities require special attention to the sovereignty of tribal governments and the unique cultural aspects of health care and communication. Pediatricians working with AI/AN children on reservations or in urban environments are strongly urged to collaborate with tribes and the IHS to create community-based coalitions and develop programs to address highly preventable injury-related mortality and morbidity. Strong advocacy also is needed to promote childhood injury prevention as an important priority for federal agencies and tribes.

Hospitalization for motor vehicle injuries among American Indians and Alaska Natives in Washington

OBJECTIVE

Little is known about the epidemiology of hospitalization for motor vehicle injury among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest. Current secondary data sources are inadequate to track this significant health problem. The purpose of this study was to determine the rate of hospitalization for motor vehicle injury in this population through linkage of Indian Health Service (IHS) patient registration data to a statewide hospital discharge database.

METHODS

To create the numerator, IHS patient registration data were linked to Washington State hospital discharge abstracts from 1990 to 1994 for motor vehicle injury (ICD-9 E-codes 810-819). The denominator for this population was derived from the total number of IHS enrollees in 1992. Comparative numerator and denominator data for all residents were derived from the discharge database and Washington State intercensal population estimates, respectively.

RESULTS

AI/ANs experienced a nearly two-fold higher rate of motor vehicle injury hospitalization (N = 588) compared to all residents [Incidence Ratio (I.R.): 1.82; 95% C.I. 1.52-2.19]. The greatest disparity in incidence rates occurred among 25-34 year olds (I.R. 2.18; 95% C.I. 1.53-3.10) and 35-44 year olds (I.R. 2.18; 95% C.I. 1.36-3.47). In-hospital mortality, severity of injury and length of stay were not different between the 2 groups. Median charges for American Indian hospitalizations were $6188 and the IHS was payer in, at most, 24% of hospitalizations.

CONCLUSIONS

AI/ANs are at higher risk of hospitalization for motor vehicle injuries but, compared to all residents of Washington, appear to have similar severity of injuries and outcomes. Motor vehicle injury hospitalization among AI/ANs incurs substantial health care costs.

Injury hospitalizations among American Indian youth in Washington

OBJECTIVE

To determine the rate and causes of hospitalizations for injury among American Indian and Alaska Native (AI/AN) youth in the state of Washington, and to compare this with the rate of hospitalizations for injury among youth of all races.

METHODS

Subjects were aged 0-19 years and were admitted to civilian hospitals for care of an injury (International Classification of Diseases N codes 800-995) in Washington between 1990 and 1994. Deaths occurring in the prehospital setting and emergency department are not included. Using several fields of identifying information, the Washington state hospital discharge database was linked with the Indian Health Service (IHS) patient registration database to identify AI/AN youth. Denominator data included the total age specific IHS user population for American Indians and US Census derived population estimates. Incidence ratios (IRs) were calculated to compare rates of hospitalization between AI/AN youth and all youth in Washington.

RESULTS

A total of 694 and 29,048 hospitalizations for injury were identified for AI/AN youth and all races, respectively. The rate of hospitalization for injuries among AI/AN youth was 507 discharges per 100,000 youth (IR = 1.30; 95% confidence interval (CI) 1.20 to 1.40. The leading mechanism of injury was motor vehicles (IR 1.73, CI 1.49 to 2.01), followed by falls (IR 0.95, CI 0.79 to 1.15), and poisoning (IR 1.20, CI 0.80 to 1.78). The disparity was greater for intentional injuries (IR 1.71, CI 1.44 to 2.04). The highest IR for all unintentional injuries was for injuries from fire (IR 2.35, CI 1.42 to 3.87). AI/AN children aged 15-19 had the greatest disparity for rates of injury hospitalization (IR 1.4, CI 1.25 to 1.56).

CONCLUSION

AI/AN youth in Washington had a higher hospitalization rate for injury compared with all youth in the state. Disparities were greatest for injuries related to motor vehicles and assaults. When linked, hospital discharge data can be used for surveillance of AI/AN hospitalizations.