title: Ectopic pregnancy among American Indian and Alaska Native women, 2002-2009.
abstract: To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS F-74, Atlanta, GA, 30341, USA, leb8@cdc.gov.
authors.forename: Lori
authors.initials: L
authors.lastname: de Ravello
authors.forename: Arianne
authors.initials: A
authors.lastname: Folkema
authors.forename: Scott
authors.initials: S
authors.lastname: Tulloch
authors.forename: Melanie
authors.initials: M
authors.lastname: Taylor
authors.forename: Brigg
authors.initials: B
authors.lastname: Reilley
authors.forename: Karen
authors.initials: K
authors.lastname: Hoover
authors.forename: Robert
authors.initials: R
authors.lastname: Holman
authors.forename: Andreea
authors.initials: A
authors.lastname: Creanga
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000413:Alaska / Q000453:epidemiology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000706:statistics & numerical data; D055815:Young Adult