141st APHA Annual Meeting and Exposition

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Online Program

279495
American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2008


Monday, November 4, 2013 : 8:30 a.m. - 8:50 a.m.

Charlene Wong, MD, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
Francine Gachupin, PhD, Department of Family and Community Medicine, University of Arizona, Tucson, AZ
Marian MacDorman, Ph.D., Division of Vital Statistics, National Center for Health Statistics, CDC, Hyattsville, MD
Rosalyn Singleton, MD, Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Anchorage, AK
Robert Holman, MS, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
James Cheek, MD, MPH, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM
Stephen Holve, MD, Indian Health Service, Tuba City Regional Healthcare Corporation, Tuba City, AZ
Objectives: To describe American Indian/Alaska Native (AI/AN) infant and pediatric mortality rates and the leading causes of death using a novel database of national mortality data adjusted for AI/AN racial misclassification.

Methods: National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification by linkage with Indian Health Service (IHS) AI/AN registration records. Mortality rates (per 100,000 persons) and leading causes of death for 1999-2008, based on ICD-10 codes, were determined for AI/AN infants (<1 year old) and children aged 1-19 years. Rates were compared to those for non-Hispanic white (NHW) infants and children using rate ratios (RRs).

Results: The AI/AN infant mortality rate was 779 (RR=1.39 versus NHW). Regionally, the rates were highest for Alaska (1147) and Northern Plains (1081). Leading causes of infant death with a higher AI/AN burden were congenital abnormalities, sudden infant death syndrome (SIDS), unintentional injuries and influenza. The overall AI/AN pediatric mortality rates were 60 (age 1-4 years, RR=2.17), 27 (5-9, RR=1.92), 37 (10-14, RR=2.07), and 148 (15-19, RR=2.46). The Northern Plains, Alaska and Southwest regions had the highest regional AI/AN mortality rates across all age groups. Unintentional injuries and suicide occurred at significantly higher rates among AI/AN youth compared to NHW.

Conclusions: AI/AN infants and children have higher mortality rates than NHW infants and children, with significant regional disparities. Several of the leading causes of death with a higher rate in AI/AN youth are potentially preventable, including unintentional injuries, SIDS, suicide and influenza.

Learning Areas:

Epidemiology
Public health or related research

Learning Objectives:
Describe American Indian/Alaska Native (AI/AN) infant and pediatric mortality rates and the leading causes of death, nationally and by IHS region. Compare AI/AN infant and pediatric mortality rates to those of non-Hispanic white infants and children.

Keyword(s): Infant Mortality, Indigenous Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a practicing pediatrician and have been involved in research of the AI/AN population through the CDC and Indian Health Services since 2008. My research focuses in this population have included infant and pediatric mortality and cancer epidemiology and prevention. I am the principal investigator on the submitted study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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