title: Increasing trend in the rate of infectious disease hospitalisations among Alaska Native people.
abstract: OBJECTIVE
  To examine the epidemiology of infectious disease (ID) hospitalisations among Alaska Native (AN) people.
  
  
  METHODS
  Hospitalisations with a first-listed ID diagnosis for American Indians and ANs residing in Alaska during 2001-2009 were selected from the Indian Health Service direct and contract health service inpatient data. ID hospitalisations to describe the general US population were selected from the Nationwide Inpatient Sample. Annual and average annual (2007-2009) hospitalization rates were calculated.
  
  
  RESULTS
  During 2007-2009, IDs accounted for 20% of hospitalisations among AN people. The 2007-2009 average annual age-adjusted ID hospitalisation rate (2126/100,000 persons) was higher than that for the general US population (1679/100,000; 95% CI 1639-1720). The ID hospitalisation rate for AN people increased from 2001 to 2009 (17%, p < 0.001). Although the rate during 2001-2009 declined for AN infants (< 1 year of age; p = 0.03), they had the highest 2007-2009 average annual rate (15106/100,000), which was 3 times the rate for general US infants (5215/100,000; 95% CI 4783-5647). The annual rates for the age groups 1-4, 5-19, 40-49, 50-59 and 70-79 years increased (p < 0.05). The highest 2007-2009 age-adjusted average annual ID hospitalisation rates were in the Yukon-Kuskokwim (YK) (3492/100,000) and Kotzebue (3433/100,000) regions; infant rates were 30422/100,000 and 26698/100,000 in these regions, respectively. During 2007-2009, lower respiratory tract infections accounted for 39% of all ID hospitalisations and approximately 50% of ID hospitalisations in YK, Kotzebue and Norton Sound, and 74% of infant ID hospitalisations.
  
  
  CONCLUSIONS
  The ID hospitalisation rate increased for AN people overall. The rate for AN people remained higher than that for the general US population, particularly in infants and in the YK and Kotzebue regions. Prevention measures to reduce ID morbidity among AN people should be increased in high-risk regions and for diseases with high hospitalisation rates.
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (USDHHS), Atlanta, GA 30333, USA. RHolman@cdc.gov
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Dana L
authors.initials: DL
authors.lastname: Haberling
authors.forename: Laura S
authors.initials: LS
authors.lastname: Callinan
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology; D055815:Young Adult
keywords: Alaska; Alaska Native; hospitalisations; infectious disease; lower respiratory tract infection