Outpatient and Hospital Visits Associated With Otitis Media Among American Indian and Alaska Native Children Younger Than 5 Years

Abstract

ABSTRACT. Objective. To describe the burden of otitis media (OM) among American Indian and Alaska Native (AI/AN) children.Methods. OM morbidity among AI/AN younger than 5 years was evaluated using OM-associated outpatient visit and hospitalization rates. These rates were compared with outpatient and hospitalization rates for the general US population of children younger than 5 years. AI/AN children who were younger than 5 years and receiving care through the Indian Health Service or tribally operated facilities and US children younger than 5 years of age were studied.Results. From 1994 -1996, the average annual rate of AI/AN OM-associated outpatient visits was 138 per 100 children younger than 5 years. Among AI/AN children younger than 1 year (infants), these rates were almost 3 times greater than those for US infants (318 vs 110 visits per 100 infants, respectively). AI/AN children 1 to 4 years of age had rates 1.5 times greater than US children of the same age (107 vs 65 visits per 100 children, respectively). AI/AN children also experienced higher rates of OMassociated hospitalization than did US children (5643 vs 2440 per 100 000 infants, 823 vs 665 per 100 000 1-to 4-year-olds).Conclusion. We found that AI/AN children, especially AI/AN infants, have higher OM-associated outpatient and hospitalization rates than those for the general US population of children. The disparity in rates suggests that additional prevention programs and continued resources are needed to reduce OM morbidity among AI/AN children. Pediatrics 2002;109(3). URL: http://www. pediatrics.org/cgi/content/full/109/3/e41; otitis media, American Indian, Alaska Native, outpatient, hospitalization.ABBREVIATIONS. OM, otitis media; AI/AN, American Indian and Alaska Native; IHS, Indian Health Service; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; NHDS, National Hospital Discharge Survey; RR, relative risk; CI, confidence interval; PCV, pneumococcal conjugate vaccine. O titis media (OM) is one of the most common and costly health problems that affect children younger than 5 years in the United States. 1,2 Approximately half of US children have an episode of OM before their first birthday, and 9 of 10 children have an episode by 5 years of age. 3,4 OM is the most common diagnosis associated with the prescription of antibiotics in the United States, 5 and when and how antibiotics should be used for this condition remains the subject of continuing debate. 6 -12 Furthermore, from 1% to 7% of children can be expected to have surgical procedures related to OM. 4,13,14 It is widely known that OM morbidity is greater among specific groups of American Indian/Alaska Native (AI/AN) children than among the general US population of children. [15][16][17][18] Recent comparisons of AI/AN OM morbidity with that of the general US population are lacking, as are aggregate estimates of OM morbidity among all AI/AN children. Therefore, we examined OM-associated outpatient and hospitalization data for AI/AN children younger t...

Infectious Disease Hospitalizations Among American Indian and Alaska Native Infants

“…10,[32][33][34] Moreover, lack of access to outpatient facilities may contribute to the higher rates in Alaska. 15 In contrast to the IHS regions, infant infectious hospitalization rates did not differ by region for the general US population.…”

“…The lower rates among AI/AN infants in the Oklahoma region are consistent with those described in other infectious disease-related studies of AI/ANs. 10,[13][14][15] Given the lower infectious disease hospitalization rates for the Oklahoma region, studies to investigate and explain regional disparities in infectious diseases among AI/ ANs may be useful. The high regional rates in the Alaska and Southwest regions were also found in studies of bronchiolitis-associated hospitalizations among AI/AN infants and otitis media-associated outpatient visits and hospitalizations among AI/AN children.…”

“…The high regional rates in the Alaska and Southwest regions were also found in studies of bronchiolitis-associated hospitalizations among AI/AN infants and otitis media-associated outpatient visits and hospitalizations among AI/AN children. 14,15 In addition, a high rate for diarrheaassociated hospitalizations among AI/AN children was reported in the Southwest region. 13 The higher rates in the Alaska and Southwest regions may be associated with household crowding and the lack of sanitation facilities that have been reported among some tribes in the Southwest and rural Native villages in Alaska.…”

“…3,9,11,12 Infectious disease morbidity, as measured through hospitalization rates, also seems to be greater among AI/AN infants than non-AI/AN infants. 10,[13][14][15] AI/AN infants account for a disproportionate share of infectious disease hospitalizations among all AI/ANs. 9,10 To understand better the infectious disease burden among AI/AN infants, we analyzed infectious disease hospitalizations among AI/AN infants who received Indian Health Service (IHS)/tribal medical care.…”

Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

“…Lower hospitalization rates associated with infectious diseases among AIs/ ANs living in the Oklahoma region were reported in other studies. 9,13,25,31 The reasons for the lower rates are not clear but could include a higher socioeconomic status among AIs/ANs living in the Oklahoma region, relative to AIs/ANs living in other IHS regions, with associated improvements in infant health. For example, AIs/ANs living in the Oklahoma region have a higher percentage of college graduates (11.4%), a lower birth rate (22.4%), and a lower infant mortality rate (7.5%), compared with AIs/ANs living in other IHS regions.…”