title: A strategy for reducing tuberculosis among Oglala Sioux Native Americans.
abstract: BACKGROUND
  The Oglala Sioux people, who live on the second largest Native American reservation in the United States, the Pine Ridge Reservation in South Dakota, have a history of high rates of tuberculosis.
  
  
  METHODS
  To determine a strategy for reducing tuberculosis in this population, Pine Ridge Reservation tuberculosis cases since 1968 were analyzed. Diabetic patients were identified through chart reviews and characterized for tuberculosis status. Age-specific tuberculosis rates and age-specific relative risks (RRs) were calculated and compared with those of South Dakota excluding Pine Ridge.
  
  
  RESULTS
  Between 1968 and 1994, the RR for tuberculosis was 18.9 for a Pine Ridge Native American compared with rates for the rest of South Dakota. The age-specific RR was 65.7 for the Pine Ridge population 65 and older from 1985-1994. Tuberculin tests were positive in 70% of diabetic patients on the reservation. Diabetic patients comprise 23% of the population 45 and older at Pine Ridge. Fifty-five percent of all the tuberculosis disease in the 45 and older age group can be prevented by eliminating it in the diabetic population.
  
  
  CONCLUSIONS
  A major stride toward reducing tuberculosis can be made by targeting high-risk groups such as diabetic patients, especially in a time of dwindling resources and personnel for tuberculosis control.
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, Michigan, USA. joebreault@worldnet.att.net
authors.forename: J L
authors.initials: JL
authors.lastname: Breault
authors.forename: M G
authors.initials: MG
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006801:Humans; D007198:Indians, North American; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013023:South Dakota / Q000453:epidemiology; D014376:Tuberculosis / Q000208:ethnology* / Q000517:prevention & control*; D014481:United States; D016549:United States Indian Health Service
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid