Abstract
IntroductionTribe-based or reservation-based data consistently show disproportionately high obesity rates among American Indian children, but little is known about the approximately 75% of American Indian children living off-reservation. We examined obesity among American Indian children seeking care off-reservation by using a database of de-identified electronic health records linked to community-level census variables.MethodsData from electronic health records from American Indian children and a reference sample of non-Hispanic white children collected from 2007 through 2012 were abstracted to determine obesity prevalence. Related community-level and individual-level risk factors (eg, economic hardship, demographics) were examined using logistic regression.ResultsThe obesity rate for American Indian children (n = 1,482) was double the rate among non-Hispanic white children (n = 81,042) (20.0% vs 10.6%, P < .001). American Indian children were less likely to have had a well-child visit (55.9% vs 67.1%, P < .001) during which body mass index (BMI) was measured, which may partially explain why BMI was more likely to be missing from American Indian records (18.3% vs 14.6%, P < .001). Logistic regression demonstrated significantly increased obesity risk among American Indian children (odds ratio, 1.8; 95% confidence interval, 1.6–2.1) independent of age, sex, economic hardship, insurance status, and geographic designation.ConclusionAn electronic health record data set demonstrated high obesity rates for nonreservation-based American Indian children, rates that had not been previously assessed. This low-cost method may be used for assessing health risk for other understudied populations and to plan and evaluate targeted interventions.
Highlights
Tribe-based or reservation-based data consistently show disproportionately high obesity rates among American Indian children, but little is known about the approximately 75% of American Indian children living off-reservation
During which body mass index (BMI) was measured, which may partially explain why BMI was more likely to be missing from American Indian records (18.3% vs 14.6%, P < .001)
Data are available for American Indian children living on reservation through the Indian Health Service (IHS), less is known about children who live and seek health care outside of IHS
Summary
Tribe-based or reservation-based data consistently show disproportionately high obesity rates among American Indian children, but little is known about the approximately 75% of American Indian children living off-reservation. Electronic health record (EHR) data sets may be wellsuited to address these data gaps; a 2013 report to the US Department of Health and Human Services highlighted the feasibility of this approach and called for examination of underserved populations using this methodology [1]. One such group is American Indian children who live outside of reservations or other tribal lands. Data are available for American Indian children living on reservation through the Indian Health Service (IHS), less is known about children who live and seek health care outside of IHS. Data characterizing the differences in aspects of health and health care in this group and other subpopulations can lead to improvements in health care quality, evidence-based research, and public health approaches.
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