Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009

doi:10.2105/AJPH.2013.301740

Comparative Study

. 2014 Jun;104 Suppl 3(Suppl 3):S460-9.

doi: 10.2105/AJPH.2013.301740. Epub 2014 Apr 22.

Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009

Amy V Groom¹, Thomas W Hennessy, Rosalyn J Singleton, Jay C Butler, Stephen Holve, James E Cheek

Affiliations

Affiliation

¹ Amy V. Groom is with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Thomas W. Hennessy is with the Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK. Rosalyn J. Singleton and Jay C. Butler are with the Alaska Native Tribal Health Consortium, Anchorage. Stephen Holve is with Tuba City Regional Health Care, Indian Health Service, Tuba City, AZ. James E. Cheek is with the University of New Mexico, Albuquerque.

PMID: 24754620
PMCID: PMC4035860
DOI: 10.2105/AJPH.2013.301740

Comparative Study

Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009

Amy V Groom et al. Am J Public Health.2014 Jun.

. 2014 Jun;104 Suppl 3(Suppl 3):S460-9.

doi: 10.2105/AJPH.2013.301740. Epub 2014 Apr 22.

Authors

Amy V Groom¹, Thomas W Hennessy, Rosalyn J Singleton, Jay C Butler, Stephen Holve, James E Cheek

Affiliation

¹ Amy V. Groom is with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Thomas W. Hennessy is with the Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK. Rosalyn J. Singleton and Jay C. Butler are with the Alaska Native Tribal Health Consortium, Anchorage. Stephen Holve is with Tuba City Regional Health Care, Indian Health Service, Tuba City, AZ. James E. Cheek is with the University of New Mexico, Albuquerque.

PMID: 24754620
PMCID: PMC4035860
DOI: 10.2105/AJPH.2013.301740

Abstract

Objectives: We compared pneumonia and influenza death rates among American Indian/Alaska Native (AI/AN) people with rates among Whites and examined geographic differences in pneumonia and influenza death rates for AI/AN persons.

Methods: We adjusted National Vital Statistics Surveillance mortality data for racial misclassification of AI/AN people through linkages with Indian Health Service (IHS) registration records. Pneumonia and influenza deaths were defined as those who died from 1990 through 1998 and 1999 through 2009 according to codes for pneumonia and influenza from the International Classification of Diseases, 9th and 10th Revision, respectively. We limited the analysis to IHS Contract Health Service Delivery Area counties, and compared pneumonia and influenza death rates between AI/ANs and Whites by calculating rate ratios for the 2 periods.

Results: Compared with Whites, the pneumonia and influenza death rate for AI/AN persons in both periods was significantly higher. AI/AN populations in the Alaska, Northern Plains, and Southwest regions had rates more than 2 times higher than those of Whites. The pneumonia and influenza death rate for AI/AN populations decreased from 39.6 in 1999 to 2003 to 33.9 in 2004 to 2009.

Conclusions: Although progress has been made in reducing pneumonia and influenza mortality, disparities between AI/AN persons and Whites persist. Strategies to improve vaccination coverage and address risk factors that contribute to pneumonia and influenza mortality are needed.

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Figures

**FIGURE 1—**
**Annual death rates for American Indians/Alaska Natives (AI/ANs) and Whites from (a) pneumonia and (b) influenza: Contract Health Service Delivery Areas, United States, 1990–2009.***Note.* Rates are per 100 000 persons and are age-adjusted to the 2000 US standard population (11 age groups; Census P25-1130⁴⁵). Analyses are limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the Indian Health Service patient registration database. The following states and years of data are excluded because Hispanic origin was not collected on the death certificate: LA: 1990; NH: 1990–1992; OK: 1990–1996. *Source*. AI/AN Mortality Database (AMD 1990–2009).

**FIGURE 2—**
**Pneumonia and influenza death rate ratios by age group for American Indians/Alaska Natives (AI/ANs) and Whites: Contract Health Service Delivery Areas, United States, 1990–2009.***Note*. Rate ratios are calculated in SEER*Stat before rounding of rates and may not equal RRs calculated from rates presented in Table 1. Analyses are limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the Indian Health Service patient registration database. The following states and years of data are excluded because Hispanic origin was not collected on the death certificate: LA 1990; NH: 1990–1992; OK: 1990–1996. *Source*. AI/AN Mortality Database (AMD 1990–2009).

**FIGURE 3—**
**Pneumonia and influenza death rates for American Indians/Alaska Natives (AI/ANs) and Whites: Contract Health Service Delivery Areas, United States, 1999–2003 and 2004–2009.***Note*. Rates are per 100 000 persons and are age-adjusted to the 2000 US standard population (11 age groups; Census P25-1130). Analyses are limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the IHS patient registration database. The following states and years of data are excluded because Hispanic origin was not collected on the death certificate: LA: 1990; NH: 1990–1992; OK: 1990–1996. *Source*. AI/AN Mortality Database (AMD 1990–2009).

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References

1. Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281(1):61–66. - PubMed
1. Hutchins SS, Fiscella K, Levine RS et al. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health. 2009;99(suppl 2):S261–S270. - PMC - PubMed
1. Singleton R, Holve S, Groom A et al. Impact of immunizations on the disease burden of American Indian and Alaska native children. Arch Pediatr Adolesc Med. 2009;163(5):446–453. - PubMed
1. Oraka E, Iqbal S, Flanders W et al. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001–2010. J Asthma. 2013;50(5):488–496. - PMC - PubMed
1. Denny CH, Holtzman D, Cobb N. Surveillance for health behaviors of American Indians and Alaska Natives. Findings from the Behavioral Risk Factor Surveillance System, 1997–2000. MMWR Surveill Summ. 2003;52(7):1–13. - PubMed

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[1] Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281(1):61–66. - PubMed

[2] Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281(1):61–66. - PubMed

[3] Hutchins SS, Fiscella K, Levine RS et al. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health. 2009;99(suppl 2):S261–S270. - PMC - PubMed

[4] Hutchins SS, Fiscella K, Levine RS et al. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health. 2009;99(suppl 2):S261–S270. - PMC - PubMed

[5] Singleton R, Holve S, Groom A et al. Impact of immunizations on the disease burden of American Indian and Alaska native children. Arch Pediatr Adolesc Med. 2009;163(5):446–453. - PubMed

[6] Singleton R, Holve S, Groom A et al. Impact of immunizations on the disease burden of American Indian and Alaska native children. Arch Pediatr Adolesc Med. 2009;163(5):446–453. - PubMed

[7] Oraka E, Iqbal S, Flanders W et al. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001–2010. J Asthma. 2013;50(5):488–496. - PMC - PubMed

[8] Oraka E, Iqbal S, Flanders W et al. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001–2010. J Asthma. 2013;50(5):488–496. - PMC - PubMed

[9] Denny CH, Holtzman D, Cobb N. Surveillance for health behaviors of American Indians and Alaska Natives. Findings from the Behavioral Risk Factor Surveillance System, 1997–2000. MMWR Surveill Summ. 2003;52(7):1–13. - PubMed

[10] Denny CH, Holtzman D, Cobb N. Surveillance for health behaviors of American Indians and Alaska Natives. Findings from the Behavioral Risk Factor Surveillance System, 1997–2000. MMWR Surveill Summ. 2003;52(7):1–13. - PubMed

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Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009

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Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009

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