title: Trends in lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general US child population.
abstract: OBJECTIVE
  To describe trends in the rate of hospitalization for lower respiratory tract infection (LRTI) among American Indian/Alaska Native (AI/AN) children and the general US population of children aged <5 years.
  
  
  METHODS
  This was a retrospective analysis of trends and hospitalization rates for LRTI-associated hospitalizations in 1998-2008 among AI/AN children aged <5 years using the Indian Health Service direct/contract inpatient data, and also among the general population of US children aged <5 years using the Nationwide Inpatient Sample.
  
  
  RESULTS
  The 2006-2008 LRTI-associated hospitalization rate for AI/AN children aged <5 years (21.8 per 1000/year) was 32% lower than the 1998-1999 rate, and 1.6-fold higher than the general US children rate (13.8 per 1000/year; 95% CI, 12.8-14.8). Higher rates were seen in AI/AN children aged <5 years in the Alaska and the Southwest regions of the United States (41.2 and 28.0 per 1000/year, respectively). In infants, these rates were 136.4 and 82.4 per 1000/year, respectively, exceeding the rate in the general US infant population (37.1 per 1000/year; 95% CI, 34.3-40.0). The greatest disparity in the LRTI-associated hospitalization rate between AI/AN infants and the general US infant population was seen for pneumonia, with a 3-fold higher rate in AI/AN infants (36.2 per 1000/year vs 12.7 per 1000/year; 95% CI, 11.8-13.6).
  
  
  CONCLUSIONS
  The LRTI-associated hospitalization rate is higher in AI/AN children, particularly infants from Alaska and the American Southwest, compared with the general US child population. Closing this gap will require addressing housing and sanitation inequities and ensuring high immunization rates and access to care.
authors.affiliation: Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA. ris2@cdc.gov
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Arianne M
authors.initials: AM
authors.lastname: Folkema
authors.forename: Jay D
authors.initials: JD
authors.lastname: Wenger
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
mesh_terms: D000413:Alaska / Q000453:epidemiology; D001988:Bronchiolitis / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy; D002675:Child, Preschool; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D014481:United States / Q000453:epidemiology