Perinatal and infant health among rural and urban American Indians/Alaska Natives

OBJECTIVES: We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health. METHODS: In this cross-sectional study of all 1989-1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight (< 2500 g), infant mortality, and cause of death for US rural and urban AI/AN and non-AI/AN populations. RESULTS: Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (18.1% vs 14.4%, P 相似文献   

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS. This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.     

Hepatitis A incidence and hepatitis a vaccination among American Indians and Alaska Natives, 1990-2001

OBJECTIVES: We assessed the effect on trends in hepatitis A incidence of the 1996 recommendation for routine hepatitis A vaccination of American Indian/Alaska Native (AIAN) children. METHODS: We examined trends in hepatitis A incidence among AIAN peoples during 1990-2001 and vaccination coverage levels among children on the largest American Indian reservation. RESULTS: Hepatitis A rates among AIANs declined 20-fold during 1997-2001. Declines in hepatitis A incidence occurred among AIANs in reservation and metropolitan areas. Among 1956 children living on the Navajo Nation whose medical records were reviewed, 1508 (77.1%) had received at least one dose of hepatitis A vaccine, and 1020 (52.1%) had completed the vaccine series. CONCLUSIONS: Hepatitis A rates among AIAN peoples have declined dramatically coincident with implementation of routine hepatitis A vaccination of AIAN children.     

Status of influenza and pneumococcal vaccination among older American Indians and Alaska Natives

Objectives. We sought to estimate the influenza and pneumococcal vaccination coverage among older American Indian and Alaska Native (AIAN) adults nationally and the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage.Methods. We obtained our sample of 1981 AIAN and 179845 White respondents 65 years and older from Behavioral Risk Factor Surveillance System data from 2003 to 2005. Logistic regression provided predictive marginal vaccination coverage for each covariate and adjusted for demographic characteristics and access to care.Results. Unadjusted influenza coverage estimates were similar between AIAN and White respondents (68.1% vs 69.5%), but pneumococcal vaccination was lower among AIAN respondents (58.1% vs 67.2%; P<.01). After multivariable adjustment for sociodemographic characteristics, self-reported coverage for both vaccines was statistically similar between AIAN and White adults.Conclusions. Although there was no disparity in influenza coverage, pneumococcal coverage was lower among AIAN than among White respondents, probably because of sociodemographic risk factors. Regional variation indicates a need to monitor coverage and target interventions to reduce disparities within geographically and culturally diverse subpopulations of AIAN persons.Racial and ethnic disparities in influenza and pneumococcal vaccinations among older adults are well documented. In the 2005 National Health Interview Survey, 63% of Whites 65 years and older in the United States reported receiving an influenza vaccine in the last 12 months, compared with 42% of Hispanics and 39% of African Americans.1 For pneumococcal vaccination, gaps of similar or greater magnitude were observed.1 These disparities have persisted over time, even as overall influenza and pneumococcal vaccination coverage has increased.2American Indians and Alaska Natives comprise approximately 1.5% of the US population,3 but they experience a significant and disproportionate burden of poor health.4 American Indian and Alaska Native (AIAN) adults are more likely than are Whites to report risk factors for chronic disease including tobacco use, obesity, diabetes, and physical inactivity, and these disparities persist among adults 55 years and older.5^,6 Rates of infant mortality and deaths associated with alcoholism, tuberculosis, and accidents are all higher among AIAN populations than among Whites, and older AIAN adults experience higher rates of invasive pneumococcal disease than does the general US population.7^,8 Urban AIAN residents, who may live farther from health facilities designated specifically for American Indians, experience similar disparities compared with general urban populations.9^,10On the basis of county- and state-level assessments using various methodologies, estimates of influenza vaccination coverage among AIAN adults 50 years and older11^,12 or 65 years and older4 range from 30% to 70%, and pneumococcal vaccination estimates range from 21% to 67%. These data suggest that in some areas, older AIAN adults receive recommended vaccines at approximately the same rate as Whites nationwide. However, there are no published estimates of vaccination coverage among a nationally based sample of AIAN adults. We sought to provide a national estimate of influenza and pneumococcal vaccination coverage among older AIAN adults (≥ 65 years) in the United States and explored the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage.     

Decrease in infant mortality and sudden infant death syndrome among Northwest American Indians and Alaskan Natives--Pacific Northwest, 1985-1996

Although the infant mortality rate (IMR) has steadily declined in the United States since the early 1900s, the rate varies among racial/ethnic populations. A goal of the national health objectives for 2010 is to eliminate racial/ethnic health disparities (U.S. Department of Health and Human Services, unpublished data, 1999). Historically, IMRs among American Indians and Alaskan Natives (AI/AN) have been high. In addition, IMRs have varied among AI/AN populations. To determine recent trends in infant mortality among Northwest AI/AN, the Northwest Portland Area Indian Health Board (NPAIHB) analyzed annual IMRs among AI/AN in Idaho, Oregon, and Washington. In addition, because sudden infant death syndrome (SIDS) is the major contributor to excess infant mortality in Northwest AI/AN, NPAIHB analyzed SIDS rates to determine whether the decline in SIDS rates in the United States also was occurring among Northwest AI/AN. This report summarizes the results of this analysis and documents dramatic decreases in both SIDS and non-SIDS infant mortality.     

Health numeracy and understanding of risk among older American Indians and Alaska Natives

American Indian and Alaska Native people suffer extreme health disparities and remain underrepresented in health research. This population needs adequate numeracy skills to make informed decisions about health care and research participation, yet little is known about their numeracy skills. Participants were 91 American Indian and Alaska Native elders who completed an anonymous survey that measured numeracy and the correlation between framing of risk and comprehension of risk. The authors measured numeracy by a previously developed 3-item scale that assessed basic probability skills and the ability to manipulate percentages and proportions. Risk comprehension was measured by 3 items on treatment benefits, which were variously framed in terms of relative risk reduction, absolute risk reduction, and number needed to treat. Framing in terms of relative risk was associated with higher odds of correct interpretation compared to absolute risk (OR=1.8, 95% CI=1.2-2.9) and number needed to treat (OR=2.0, 95% CI=1.2-3.5). This association persisted after adjusting for covariates, including baseline numeracy skills. Our results underscore the need for clinicians to consider how health information is framed and to check carefully for understanding when communicating risk information to patients.     

Estimation of the incidence of sudden infant death syndrome in Korea: using the capture-recapture method

This study was undertaken to estimate the incidence of sudden infant death syndrome (SIDS) for 2 years from 1997 to 1998 in Korea. The information on SIDS was obtained from three independent sources, the Korean Medical Insurance Corporation data, data from different medical facilities (Korean surveillance on SIDS) and mortality data from the Korean National Statistical Office. A log linear model with no interactions among the 3 sources was used with the selection criteria of both the Akaike Information Criterion and the Bayesian Information Criterion. The 95% confidence intervals of the estimated number of SIDS deaths were calculated using the goodness-of-fit-method. The estimated number of deaths who were not found in any of the sources was 535, and the estimated total number of SIDS deaths was 759. The 95% confidence interval for estimated total number of patients ranged from 642 to 1522. The estimated rate of SIDS cases was 0.56 per 1000 live births per annum, which is similar to the incidence in the USA or Japan.     

Cigarette smoking as a risk factor for sudden infant death syndrome: a population-based study.

Risk factors for sudden infant death syndrome (SIDS) were examined in a prospective study based on Swedish births between 1983 and 1985. All infants surviving the first week of life were included (279,938). The overall rate of SIDS was 0.7 per 1,000 first week survivors. Elevated relative risks were associated with low maternal age, multiparity, maternal smoking, and male infants. Smoking doubled the risk and a clear dose-response relation by amount smoked was observed. Maternal smoking also seemed to influence the time of death, as infants of smokers died at an earlier age. In countries like Sweden, smoking may be the single most important preventable risk factor for sudden infant death syndrome.     

The incidence of sudden infant death syndrome in North Carolina''s cities and counties: 1972--1974

Between January 1, 1972 and December 31, 1974, 534 Sudden Infant Death Syndrome cases were reported in North Carolina. All but the out-of-state cases were mapped by county and city locations to determine if urban or rural cases predominated. The mapping was also undertaken to see if significant spatial variabilities could be detected between the county and city populations of infants at risk. The state had an overall SIDS rate of 2.06 per thousand live births. The mapping revealed that counties had a range from zero to a high of 6.6 and that cities with populations of over 10,000 had SIDS rates which ranged from zero to a high of 10.6. The proportions of SIDS cases occurring in either urban or rural locations roughly approximated the distribution of the state's population, with neither location accounting for disproportionately more cases. The larger cities, however, reported more cases than did their suburbs and the immediately surrounding rural areas. The largest and smallest cities, when grouped accordingly, had the lowest urban SIDS rates. The summary SIDS rates for whites was 1.23 per thousant live births, for blacks it was 3.75, and for Indians it was 6.56 per thousand live births.     

Maternal smoking, low birth weight, and ethnicity in relation to sudden infant death syndrome

To determine independent effects of maternal smoking and infant low birth weight (less than 2,500 g) on risk of sudden infant death syndrome (SIDS) among different ethnic groups, the authors conducted a population-based case-control study based on the 1984-1989 Washington State birth record data. Two control groups were selected for 916 SIDS cases. The first one comprised 3,704 randomly selected controls, matched to cases by birth year, to describe the characteristics of the study population. In the second control group (n = 6,186), minorities were oversampled, by matching to cases on maternal race/ethnicity and birth year, to increase the power of analysis within each ethnic group. All subjects were classified into five groups on the basis of maternal race/ethnicity: white, black, American Indian, Asian, and Hispanic. After controlling for confounders, the authors found that maternal smoking was independently associated with SIDS among white (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.8-2.6), blacks (OR = 3.1, 95% CI 1.7-5.9), Asians (OR = 2.7, 95% CI 1.1-6.6, and Hispanics (OR = 5.5, 95% CI 1.4-22.0), but had little relation among American Indians (OR = 1.4, 95% Cl 0.9-2.4). Infant low birth weight was independently related to SIDS among whites (OR = 2.5, 95% Cl 1.8-3.4) and American Indians (OR = 5.5, 95% Cl 2.8-11.2) and to a lesser extent among blacks (OR = 1.9, 95% Cl 0.8-4.1), but not among Asians (OR = 1.1, 95% Cl 0.2-5.2) or Hispanics (OR = 1.2, 95% Cl 0.1-11.5). The misclassification that may occur because of the application of the same definition of low birth weight to all ethnic groups may be the main reason for the weaker association between infant low birth weight and SIDS among blacks and the absence of an association among Asians and Hispanics. Defining low birth weight as below population mean minus 1.96 standard deviations may provide better insight into the relation between low birth weight and SIDS. Understanding the reasons for the lack of a strong association between maternal smoking during pregnancy and SIDS among American Indians may enhance our knowledge of the etiology and pathogenesis of SIDS.     

Air pollution and sudden infant death syndrome: a literature review

Although the rate of sudden infant death syndrome (SIDS) has been reduced with the 'Back to Sleep' campaign, SIDS is still a common cause of death in infancy. A range of environmental factors may interact to contribute to the adverse health conditions conducive to SIDS. Nine studies have evaluated the association between exposure to air pollution and the incidence of SIDS. The available evidence is inadequate to come to any conclusion about a relationship between air pollution and SIDS, although the body of evidence appears to suggest that air pollution (especially particles and some gaseous pollutants) may play a certain role in the occurrence of SIDS. We suggest that future studies should focus on the research design, role of indoor air quality and the effect of smaller particles, particularly those in the ultrafine range.     

Epidemiologic profile of HIV and AIDS among American Indians/Alaska Natives in the USA through 2000

Objectives To describe HIV and AIDS among American Indians/Alaska Natives (AI/AN) in the USA through 2000.

Design An epidemiologic profile was constructed using HIV/AIDS surveillance, sexually transmitted disease (STD), and seroprevalence data.

Results Although AIDS among AI/AN represents <1% of cumulative AIDS cases in the USA, in 2000 the AIDS incidence rate (cases per 100,000 population) for AI/AN (11.9) was higher than that for whites (7.3). AI/AN had high rates of chlamydia, gonorrhea, and syphilis from 1996 through 2000; among all females, AI/AN females had the second highest rates of chlamydia, gonorrhea, and syphilis reported during this time period. Of all AIDS cases among AI/AN, 70% were reported by 10 states.

Conclusions These data demonstrate that the impact of STDs and the potential for an impact of HIV/AIDS among AI/AN are greater than indicated by the relatively small number of AIDS cases in this population. Additional mechanisms are needed to fill gaps in the available data. Coordination among the complex network of healthcare providers, tribes, and federal, state, and local health agencies is needed to improve delivery of information about HIV/AIDS to AI/AN and to ensure access to HIV prevention and treatment programs for AI/AN.     

The descriptive epidemiology of sudden infant deaths among natives and whites in Alaska

From 1976-1980, the incidence of sudden infant deaths among native Alaskans was 2.9 times higher than that for white Alaskans (6.28 per 1,000 live births among natives vs. 2.14 per 1,000 live births among whites). Linked birth and death vital records data were used to compare the age-at-death distributions and relative risks associated with demographic factors for natives and whites. The purpose of the comparisons was to seek clues to the etiology of sudden infant death in natives. The age-at-death distributions for natives and whites were virtually identical (mean age at death 90.4 +/- 7.0 days for natives; 87.8 +/- 6.5 days for whites). The associations between the risk of sudden death and birth weight, marital status, season of birth, and residence were similar for natives and whites. The risk associated with young maternal age (less than 20 years) was significantly higher for whites than for natives (3.20 vs. 1.38). The sex ratio for sudden deaths among whites significantly favored males (relative risk = 1.78; female = reference); a significant sex ratio was not apparent for natives. Vital records data were useful for confirming the native-white difference in sudden infant death incidence, but not for elucidating etiologic differences between natives and whites.     

Epidemiologic comparisons of the sudden infant death syndrome with other major components of infant mortality

All 1998 resident infant deaths in the 1969--1977 King County, Washington birth cohort of 139,132 resident live births comprise the data base for epidemiologic comparisons of the sudden infant death syndrome (SIDS) with eight other major infant mortality components: hyaline membrane disease; respiratory distress syndrome; asphyxia of the newborn; immaturity; birth injury; congenital malformation; infection; and "all other." These components were compared with respect to age at death; sex; race; prior fetal loss; prior live-born, now dead; birth plurality; birth weight; maternal age; birth order; marital status; prenatal care; and season of death in an attempt to determine the uniqueness of these purported SIDS risk factors. Only the age at death distribution unequivocally distinguished SIDS from the other components. The combination of low maternal age and multiparity was demonstrated to be putatively synergistic for risk of SIDS, hyaline membrane disease, and respiratory disease syndrome. Only deaths from infection exhibited seasonal variation similar to SIDS. These observations probably reflect secondary associations with as yet unidentified primary risk factors relatable to maternal experience.     

Models of mystery: physician and patient perceptions of sudden infant death syndrome

Sudden infant death syndrome or SIDS is the term applied to unexplained infant deaths. This syndrome is distinguished by a lack of knowledge about its cause, pathophysiology, and possibilities for prevention. Given these uncertainties, SIDS provides an opportunity to investigate what types of explanatory models are constructed by physicians and patients when relatively little is known about a condition, and how these models may be translated into clinical practice. Interviews about SIDS were conducted with members of a Pediatric Pulmonary Section and their high risk patients, and the clinical interactions between the staff and families were observed. The pulmonary model focused on physiological causes which might affect respiration, and reflected uncertainty in both content and variability. Parents largely accepted the respiratory hypothesis, although they also considered nonphysiological causes. They tended to manage the uncertainty by focusing on ways to prevent SIDS and by believing they could predict which babies might die. However, observations of clinical interactions revealed that very little of the uncertainty as perceived by either the staff or the parents was discussed. The staff is able to emphasize hope for a particular patient, despite the uncertainty that surrounds SIDS, by following an explicit protocol which states how to handle a child despite the theoretical unknowns, and focusing on the knowns about the particular baby's condition.     

Timing of prenatal care and risk of sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the leading cause of death during post-neonatal life. Mothers whose infants succumb to SIDS are reported to initiate prenatal care later than control mothers. Previous studies have not always controlled for socioeconomic status (SES) of mothers or other potential confounders such as gestational age or birthweight of infants. The purpose of this study was to assess whether timing of prenatal care adjusted for these potential confounders was an independent risk factor for SIDS. SIDS cases (N = 148) were identified from the Upstate New York livebirth cohort for 1974 (N = 132,948) and compared to randomly selected controls (N = 355) who were frequency-matched on maternal age, race, parity and residence and infant's birth date. Data were abstracted from matched vital certificates (97% response), hospital delivery records (89% response) and selected sample of autopsy reports (100% response). Odds ratios (OR) and 95% confidence intervals (CI) were obtained using unconditional logistic regression. A significant inverse relationship was observed for number of prenatal visits and risk of SIDS; a significant direct relationship was observed between trimester prenatal care initiated and risk of SIDS. The results suggest that timing of prenatal care is important in assessing SIDS risk even after adjusting for potential confounders of early prenatal care utilization.     

Maternal placental abnormality and the risk of sudden infant death syndrome

To determine whether placental abnormality (placental abruption or placental previa) during pregnancy predisposes an infant to a high risk of sudden infant death syndrome (SIDS), the authors conducted a population-based case-control study using 1989-1991 California linked birth and death certificate data. They identified 2,107 SIDS cases, 96% of whom were diagnosed through autopsy. Ten controls were randomly selected for each case from the same linked birth-death certificate data, matched to the case on year of birth. About 1.4% of mothers of cases and 0.7% of mothers of controls had either placental abruption or placenta previa during the index pregnancy. After adjustment for potential confounders, placental abnormality during pregnancy was associated with a twofold increase in the risk of SIDS in offspring (odds ratio = 2.1, 95% confidence interval 1.3-3.1). The individual effects of placental abruption and placenta previa on the risk of SIDS did not differ significantly. An impaired fetal development due to placental abnormality may predispose an infant to a high risk of SIDS.     

Relationship between the incidence of sudden infant death syndrome (SIDS) and other causes of infant mortality in the industrialised countries

Summary. This study compared the incidence of sudden infant death syndrome (SIDS) in 12 industrialised countries during the 1980s with that of other known causes of infant mortality using WHO demographic data. Regression analysis showed a statistically significant negative relationship between registered SIDS rate and infant mortality rate, as a result of perinatal conditions. The results are discussed, and possible explanations are suggested.