Hospitalizations at Nonfederal Facilities for Lower Respiratory Tract Infection in American Indian and Alaska Native Children Younger than 5 Years of Age, 1997-2012

Abstract

Objectives: To evaluate hospitalizations at nonfederal facilities for lower respiratory tract infection (LRTI) in American Indian/Alaska Native (AI/AN) children and to compare associated rates and risk factors in AI/AN children and white children.

Study design: We used Kids' Inpatient Database samples from 1997-2012 to identify discharges in non-Hispanic AI/AN and white children ages <5 years with a principal or secondary diagnosis code indicating LRTI. To address systematic underreporting and misclassification of race in administrative databases, population rates were estimated by deriving race- and year-specific denominators from hospital births.

Results: During the study period, LRTI-associated discharge rates (per 1000) declined for white children (from 14.8 to 10.9; P < .001 for trend). For AI/AN children, rates varied widely by census region and were highest in the West, where they ranged from 38.6 in 1997 to 26.7 in 2012 (P = .35 for trend). Discharges in AI/AN children were associated with low household income, Medicaid insurance, and rural residence. In a case-cohort analysis of infants hospitalized with LRTI in 2012, discharge rates were higher for AI/AN infants than for white infants only in the West (72.8 vs 22.2; aOR, 2.5; 95% CI, 1.8-3.4).

Conclusions: Among young children who use nonfederal hospitals, LRTI-associated hospitalizations occur at substantially higher rates for AI/AN children than for white children. These hospitalizations occur at rates that are particularly high for AI/AN infants in the West, where rates are comparable with those reported for Indian Health Service enrollees.

Keywords: Kids' Inpatient Database; health disparities; pneumonia.