A strategy for reducing tuberculosis among Oglala Sioux Native Americans.
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.
Breault
J L
JL
University of Michigan School of Public Health, Ann Arbor, Michigan, USA. joebreault@worldnet.att.net
Hoffman
M G
MG
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
D000995:Antitubercular Agents; D007538:Isoniazid