title: Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009.
abstract: OBJECTIVE
  We compared pneumonia and influenza death rates among American Indian/Alaska Native (AI/AN) people with rates among Whites and examined geographic differences in pneumonia and influenza death rates for AI/AN persons.
  
  
  METHODS
  We adjusted National Vital Statistics Surveillance mortality data for racial misclassification of AI/AN people through linkages with Indian Health Service (IHS) registration records. Pneumonia and influenza deaths were defined as those who died from 1990 through 1998 and 1999 through 2009 according to codes for pneumonia and influenza from the International Classification of Diseases, 9th and 10th Revision, respectively. We limited the analysis to IHS Contract Health Service Delivery Area counties, and compared pneumonia and influenza death rates between AI/ANs and Whites by calculating rate ratios for the 2 periods.
  
  
  RESULTS
  Compared with Whites, the pneumonia and influenza death rate for AI/AN persons in both periods was significantly higher. AI/AN populations in the Alaska, Northern Plains, and Southwest regions had rates more than 2 times higher than those of Whites. The pneumonia and influenza death rate for AI/AN populations decreased from 39.6 in 1999 to 2003 to 33.9 in 2004 to 2009.
  
  
  CONCLUSIONS
  Although progress has been made in reducing pneumonia and influenza mortality, disparities between AI/AN persons and Whites persist. Strategies to improve vaccination coverage and address risk factors that contribute to pneumonia and influenza mortality are needed.
authors.affiliation: Amy V. Groom is with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Thomas W. Hennessy is with the Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK. Rosalyn J. Singleton and Jay C. Butler are with the Alaska Native Tribal Health Consortium, Anchorage. Stephen Holve is with Tuba City Regional Health Care, Indian Health Service, Tuba City, AZ. James E. Cheek is with the University of New Mexico, Albuquerque.
authors.forename: Amy V
authors.initials: AV
authors.lastname: Groom
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: Jay C
authors.initials: JC
authors.lastname: Butler
authors.forename: Stephen
authors.initials: S
authors.lastname: Holve
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000208:ethnology* / Q000401:mortality*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000208:ethnology* / Q000401:mortality*; D011159:Population Surveillance; D012042:Registries; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
references.citation: Pediatrics. 2004 Oct;114(4):e437-44
references.pmid: 15466069
references.citation: Am J Public Health. 2014 Jun;104 Suppl 3:S481-9
references.pmid: 24754662
references.citation: Clin Infect Dis. 2011 Jan 1;52 Suppl 1:S189-97
references.pmid: 21342894
references.citation: Am J Public Health. 2008 Nov;98(11):2072-8
references.pmid: 18382002
references.citation: MMWR Surveill Summ. 2011 May 20;60(6):1-44
references.pmid: 21597458
references.citation: mBio. 2011 Jan 25;2(1):e00309-10
references.pmid: 21264063
references.citation: JAMA. 1999 Jan 6;281(1):61-6
references.pmid: 9892452
references.citation: Epidemiol Rev. 1990;12:149-78
references.pmid: 2286216
references.citation: Pediatrics. 2009 Oct;124(4):e768-76
references.pmid: 19786437
references.citation: Am J Public Health. 2014 Jun;104 Suppl 3:S286-94
references.pmid: 24754557
references.citation: Pediatrics. 2002 Feb;109(2):210-6
references.pmid: 11826197
references.citation: Public Health Rep. 2011 Jul-Aug;126(4):508-21
references.pmid: 21800745
references.citation: Natl Health Stat Report. 2010 Mar 9;(20):1-22
references.pmid: 20583451
references.citation: Vaccine. 2007 Mar 8;25(12):2288-95
references.pmid: 17254673
references.citation: Cancer. 2014 May 1;120(9):1290-314
references.pmid: 24343171
references.citation: Clin Infect Dis. 2010 May 1;50(9):1238-46
references.pmid: 20367225
references.citation: Clin Infect Dis. 2004 Feb 15;38(4):496-501
references.pmid: 14765341
references.citation: Pediatr Infect Dis J. 2010 Mar;29(3):251-6
references.pmid: 19952861
references.citation: Pediatr Infect Dis J. 2005 Apr;24(4):342-51
references.pmid: 15818295
references.citation: Am J Public Health. 2014 Jun;104 Suppl 3:S295-302
references.pmid: 24754617
references.citation: Clin Chest Med. 2012 Dec;33(4):649-65
references.pmid: 23153607
references.citation: J Asthma. 2013 Jun;50(5):488-96
references.pmid: 23544662
references.citation: Am J Public Health. 1981 Jun;71(6):643-5
references.pmid: 7235106
references.citation: Cancer. 2008 Sep 1;113(5 Suppl):1131-41
references.pmid: 18720374
references.citation: Am J Epidemiol. 1999 Feb 1;149(3):282-9
references.pmid: 9927225
references.citation: Proc Natl Acad Sci U S A. 1999 Feb 16;96(4):1651-6
references.pmid: 9990079
references.citation: Am J Epidemiol. 2004 Aug 1;160(3):270-8
references.pmid: 15258000
references.citation: Public Health Rep. 2006 Nov-Dec;121(6):674-83
references.pmid: 17278402
references.citation: Am J Public Health. 2009 Oct;99 Suppl 2:S271-8
references.pmid: 19461107
references.citation: Vaccine. 2009 Aug 21;27 Suppl 3:C9-C14
references.pmid: 19683658
references.citation: Pediatr Infect Dis J. 1996 Oct;15(10):859-65
references.pmid: 8895916
references.citation: Ann Epidemiol. 2011 Aug;21(8):623-30
references.pmid: 21737049
references.citation: MMWR Surveill Summ. 2003 Aug 1;52(7):1-13
references.pmid: 14532869
references.citation: Vaccine. 2011 Jul 26;29(33):5355-62
references.pmid: 21664217
references.citation: Vital Health Stat 2. 2008 Oct;(148):1-23
references.pmid: 19024798
references.citation: Pediatrics. 2012 May;129(5):e1220-7
references.pmid: 22508919
references.citation: Pediatrics. 1985 Mar;75(3):594-7
references.pmid: 3975130
references.citation: J Infect Dis. 2010 Jan 1;201(1):32-41
references.pmid: 19947881
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Dec 11;58(48):1341-4
references.pmid: 20010508
references.citation: Pediatr Infect Dis J. 2007 Nov;26(11 Suppl):S46-50
references.pmid: 18090200
references.citation: Pediatrics. 2003 Feb;111(2):E176-82
references.pmid: 12563092
references.citation: Pediatr Infect Dis J. 2005 Aug;24(8):729-30
references.pmid: 16094230
references.citation: Influenza Other Respir Viruses. 2013 Nov;7(6):1361-9
references.pmid: 23721100
references.citation: J Antimicrob Chemother. 2011 May;66(5):959-63
references.pmid: 21406435
references.citation: Am J Public Health. 2001 Mar;91(3):425-31
references.pmid: 11236408
references.citation: Natl Vital Stat Rep. 2001 May 18;49(2):1-32
references.pmid: 11381674
references.citation: Hum Vaccin. 2005 Mar-Apr;1(2):66-9
references.pmid: 17038821
references.citation: JAMA. 2007 Apr 25;297(16):1784-92
references.pmid: 17456820
references.citation: Arch Pediatr Adolesc Med. 2009 May;163(5):446-53
references.pmid: 19414691
references.citation: Am J Public Health. 2009 Oct;99 Suppl 2:S261-70
references.pmid: 19797739
references.citation: J Pediatr. 2008 May;152(5):666-70
references.pmid: 18410771
references.citation: JAMA. 2003 Jan 8;289(2):179-86
references.pmid: 12517228
references.citation: Stat Methods Med Res. 2006 Dec;15(6):547-69
references.pmid: 17260923
references.citation: J Pediatr. 2012 Aug;161(2):296-302.e2
references.pmid: 22437150
references.citation: Am J Dis Child. 1990 Jan;144(1):105-8
references.pmid: 2294707