Analysis of prior health system contacts as a harbinger of subsequent fatal injury in American Indians.
BACKGROUND
Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American Indians living in the northern plains.


OBJECTIVE
The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation.


METHODS
Death certificates of American Indians who died from injury (ICD-9-E 800-999) in a rural IHS area over 6 consecutive years were linked to IHS acute-care facility records and toxicology reports. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Of the 526 injury deaths involving American Indians in the IHS area studied, 411 (78%) were successfully linked to IHS records. One hundred fifty-two of these cases met the inclusion criteria, with an additional 98 cases identified as a comparison group.


RESULTS
No differences in alcohol use at time of death between groups with and without prior health care contact (for injury or alcohol) could be determined (81% vs 73%). A significant relationship was found between previous visits for acute or chronic alcohol use and subsequent alcohol-related fatalities (P =.01).


CONCLUSIONS
Based on these findings, injury-prevention activities in the population studied should be initiated at the time of any health-system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients.
Sanddal
Teri L
TL
Critical Illness and Trauma Foundation, Inc, Bozeman, MT 59715, USA. tsanddal@citmt.org
Upchurch
James
J
Sanddal
Nels D
ND
Esposito
Thomas J
TJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000208:ethnology* / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D005568:Forms and Records Control / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009009:Montana / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service; D014947:Wounds and Injuries / Q000208:ethnology* / Q000401:mortality*; D014959:Wyoming / Q000453:epidemiology