title: Changing trends in viral hepatitis-associated hospitalizations in the American Indian/Alaska Native population, 1995-2007.
abstract: OBJECTIVE
  We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care.
  
  
  METHODS
  We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995-2007 and summary periods 1995-1997 and 2005-2007.
  
  
  RESULTS
  Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995-1997 to 0.8 per 100,000 population during 2005-2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45-64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45-64 years, males, and those in the Alaska region.
  
  
  CONCLUSIONS
  Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
authors: Indian Health Service, Office of Public Health Support, Division of Epidemiology and Disease Prevention, Albuquerque, NM, USA. gdn8@cdc.gov
authors: Kathy K
authors: KK
authors: Byrd
authors: John T
authors: JT
authors: Redd
authors: Robert C
authors: RC
authors: Holman
authors: Dana L
authors: DL
authors: Haberling
authors: James E
authors: JE
authors: Cheek
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006525:Hepatitis, Viral, Human / Q000145:classification / Q000453:epidemiology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000706:statistics & numerical data / Q000639:trends; D055815:Young Adult