Trends in asthma-related admissions among American Indian and Alaskan Native children from 1979 to 1989

Objective: To describe changes in asthma-related hospitalizations in Indian Health Service facilities and compare with national trends. Design: Trend analysis. Patients and Setting: Hospital discharge records of patients aged 17 years and younger treated by the Indian Health Service between 1979 and 1989. Main Outcome Measures: Patients discharged with asthma as the first listed diagnosis. Results: 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. Conclusions: 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. (Arch Pediatr Adolesc Med. 1994;148:357-363)
The health status of and use of medical care by Native Americans may provide information on the value of universal coverage, because they receive complete care from the US Indian Health Services (IHS). Because of the comprehensive services supplied by the IHS, Native American and Alaskan Native children with asthma have hospitalization rates more like white children than black children despite having socioeconomic characteristics more like black children. Hospital discharge records between 1979 and 1989 were examined for 5889 admissions of children younger than 17 years old with a diagnosis of asthma. Hospitalization rates for asthma treatment rose during the 1980s. However, the percentage increase was 3.7%, which resembled that of white children (3.4%) more than black children (6.8%). The percentage of native American children who lived below poverty threshold (41.0%) resembled the black population (32.5%) more than the white population (10.2%).