title: Analysis of prior health system contacts as a harbinger of subsequent fatal injury in American Indians.
abstract: 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.
authors.affiliation: Critical Illness and Trauma Foundation, Inc, Bozeman, MT 59715, USA. tsanddal@citmt.org
authors.forename: Teri L
authors.initials: TL
authors.lastname: Sanddal
authors.forename: James
authors.initials: J
authors.lastname: Upchurch
authors.forename: Nels D
authors.initials: ND
authors.lastname: Sanddal
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Esposito
mesh_terms: 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