Indian Health Service Facilities Research Articles

Trends in Asthma-Related Admissions Among American Indian and Alaskan Native Children From 1979 to 1989

To describe changes in asthma-related hospitalizations in Indian Health Service facilities and compare with national trends. Trend analysis. Hospital discharge records of patients aged 17 years and younger treated by the Indian Health Service between 1979 and 1989. Patients discharged with asthma as the first listed diagnosis. The rates of asthma-related hospitalizations increased an average of 2.6% (95% confidence interval [CI], 0.1 to 5.2) per year between 1979 and 1989 among American Indian and Alaskan Native children aged 0 to 17 years. The increase was 3.7% among the 0- to 4-year age group (95% CI, 2.0 to 5.5) and 0.3% (95% CI, 0.26 to 0.3) among the 5- to 17-year age group. Boys tended to have a higher rate of increase (4.3% [95% CI, -0.1 to 8.7]) compared with girls (2.6% [95% CI, -0.2 to 5.4]). The rates for any hospitalization decreased during this period for 0- to 4-year-olds (-7.5% [95% CI, -10.5 to -4.5]). Little change was noted in hospitalization rates for lower respiratory tract diseases. Diagnostic transfer from bronchitis/bronchiolitis to asthma could not explain the increase. Both first admission and readmission for treatment of asthma contributed to the increase. Compared with previously published data, 0- to 4-year-old American Indian and Alaskan Native children more closely approximate white children than black children in both rates of hospitalization (1979-1987) and annual percentage increase in hospitalization (1979-1989 for American Indian and Alaskan Native children and 1979-1987 for white and black children) for the treatment of asthma. American Indian and Alaskan Native children who are cared for by the Indian Health Service have asthma-related hospitalization patterns that are similar to those seen in white children despite having socioeconomic characteristics more similar to those of black children.

Diabetic retinopathy in Oklahoma Indians with NIDDM. Incidence and risk factors.

To determine the incidence rates and risk factors for development of diabetic retinopathy in Oklahoma Indians. Cohort follow-up study with baseline examination between 1972 and 1980 and follow-up examination between 1987 and 1991. Mean +/- SD follow-up time was 12.8 +/- 1.7 yr. Eleven Indian Health Service facilities (clinics and hospitals) in Oklahoma participated in the study. Study participants were a quasirandom sample of 1012 American Indians (379 men, 633 women) in Oklahoma with NIDDM, 927 of whom received a detailed eye examination at baseline. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. The average quantum of Indian blood was 92% (77% full blood). At follow-up, 515 (55.6%) were alive, 408 (44.0%) were deceased, and 4 (0.4%) could not be traced. Of the living participants, 380 (73.8%) underwent an ophthalmoscopic examination. The incidence of retinopathy among the participants who were free of disease at baseline and who survived the follow-up interval was 72.3%. By multivariate analysis, significant independent predictors of retinopathy recorded at baseline were FPG level, therapeutic regimen, systolic blood pressure, and duration of diabetes. FPG levels > or = 11.1 mM (200 mg/dl) increased the risk of retinopathy 1.7 times that for levels < 7.8 mM (140 mg/dl). Insulin use was associated with a 20% greater incidence. Hypertension was a particularly significant risk factor for those with lower FPG levels. Given that NIDDM is reaching epidemic proportions in Oklahoma Indians and that most may be afflicted with retinopathy, frequent ophthalmological examinations are clearly indicated for this high-risk population. The role of intervention, namely glycemic and hypertensive control, deserves further study.

Life events and daily hassles and uplifts as predictors of hospitalization and outpatient visitation

Increased occurrence of major life events and daily “hassles” and “uplifts” have been shown to be associated with several measures of health status and health care utilization. In order to test for such an association with hospital admission, a prospective study was designed. Navajo Indians presenting for either inpatient or outpatient health care at a U.S. Indian Health Service facility were questioned regarding the occurrence of major life events in the preceding six months and of hassles and uplifts in the preceding week. Two years later the subsequent numbers of outpatient visits and of hospital admissions were determined for each subject. An increased number of either major life events (relative risk 1.66) or daily hassles and uplifts (relative risk 1.87) was found to be associated with an increased risk of hospital admission. The effects of major and daily life events were additive on the risk of admission. In addition, hassles were predictive of subsequent outpatient utilization. While further demonstrating the influence of major and daily life occurrences on health care utilization, this study also shows their importance in an additional cultural setting.

Leads from the MMWR. Indian Health Service facilities become smoke-free

Leads from the MMWR. Indian Health Service facilities become smoke-free

Use of Health Services in Relation to the Physical Home Environment of an Indian Population

THE GENERAL HEALTH alertness of a community can be measured by a number of indices. These indices include variables such as the number of patient visits, the general nature of such visits (specific illnesses, the result of accidents, or preventive services), the number of hospitalizations, or possibly the general condition of housing and the environment. In this study we sought to document the relationship between the physical status of a person's home environment and the way he uses the medical services available to him. We examined some patterns in the use of health care services, how the health facilities were used, and the physical home environment of an Indian population on a reservation in the northwestern part of the United States. We also included a few persons on the reservation who did not use the available Indian Health Service clinic facilities. Additionally, we identified those who visited the clinic but did not avail themselves of the preventive health care services, assuming that identifying them would facilitate the development of a program to establish optimum health levels in that population. In sum, then, we sought answers to the following questions. What are the characteristics of the people in this study? How are the Indian Health Service facilities used and by which people? What is the relationship between the home environment and the use of health services? Which people do not use the available preventive services?

Letter to the Editor

Dr. Zinaman misinterpreted the report of the Committee on Indian Health. The report did not state that the Oklahoma City Area, Indian Health Service (IHS) was a prototype for the entire Indian Health Service. However, it did state that it was hoped that the exchange program which has been established in the Oklahoma City Area, IHS, in which residents in pediatrics at the Children's Memorial Hospital, University of Oklahoma Medical Center, are exchanged with medical officers at IHS facilities might serve as a prototype for the initiation of exchange programs in other geographic areas.

Suicides and Homicides among Indians

THE purpose of this paper is to compare suicide and homicide statistics for American with those for the general U.S. population. The Indian Health Service (IHS) is responsible for providing comprehensive health services to about 400,000 Indians, Aleuts, and Eskimos residing in 24 Federal Reservation States, primarily west of the Mississippi. Another 150,000 in those 24 States are not provided services by the Indian Health Service, mainly because they live off the reservations and long distances from IHS facilities. With the exception of table 3 and the discussion related to it, all references in this paper to Indians mean the total estimate of 550,000 Indians, Aleuts, and Eskimos in those 24 States. Table 3, in which the vital events are presented by sex, is based on the total Indian population in all 50 States, including Aleuts and Eskimos beginning with 1964. This total population was estimated at 630,000 in 1967. The sources of the statistics on are tabulations derived from data furnished to the Indian Health Service by the Vital Statistics Division of the National Center for Health Statistics, Public Health Service. Figures for the United States were derived from data appearing in Vital Statistics of the United States, published annually by the National Center for Health Statistics. Indian deaths from suicide and homicide in 1967 rose substantially over the numbers in past years, pushing these two causes into the leading 10. Suicide was the 10th leading cause of death in 1967, up from 13th in each of the previous 8 years. Homicide moved up to eighth from 11th or 12th during the previous 8 years. The 13 leading causes of Indian death in 1967, in order, were accidents; diseases of the heart; malignant neoplasms; influenza and pneumonia, except of the newborn; certain diseases of early infancy; vascular lesions affecting the central nervous system; cirrhosis of the liver; homicide; diabetes mellitus; suicide; tuberculosis, all forms; gastritis, duodenitis, enteritis, and colitis, except diarrhea of the newborn; and congenital malformations.