title: Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population.
abstract: BACKGROUND
  The lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998-2008, yet remained 1.6 times higher than the general US child population in 2006-2008.
  
  
  OBJECTIVE
  Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years.
  
  
  METHODS
  A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009-2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998-1999 rates prior to pneumococcal conjugate vaccine introduction.
  
  
  RESULTS
  The average annual LRTI-associated hospitalization rate declined from 1998-1999 to 2009-2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009-2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6-14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009-2010 H1N1 influenza-associated hospitalizations.
  
  
  CONCLUSIONS
  Although the LRTI-associated hospitalization rate declined, the 2009-2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Foote
authors.affiliation: Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.|Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA; Ris2@cdc.gov.
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.affiliation: Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.affiliation: Division of High-Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Seeman
authors.affiliation: Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD, USA.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
authors.affiliation: Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Bartholomew
authors.affiliation: Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
mesh_terms: D000367:Age Factors; D000413:Alaska / Q000453:epidemiology; D000072957:Alaska Natives / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000208:ethnology*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000706:statistics & numerical data
keywords: Alaska Native; American Indian; epidemiology; pneumonia; respiratory