摘要：Objectives. We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. Methods. We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. Results. The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. Conclusions. Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable. Infant mortality is considered one of the most important indicators of a nation’s health and social well-being, whereas pediatric mortality is a fundamental metric of children’s health. In the United States, marked racial and ethnic disparities in infant and child mortality and morbidity have been consistently documented, but are poorly understood. 1–5 Previous studies demonstrated a persistently high burden of infant and pediatric mortality among the American Indian/Alaska Native (AI/AN) population. For example, the infant mortality risk among AI/AN infants was approximately 76% higher than White infants in 6 states with high AI/AN populations in 1980. 6 More recently in 2009, the national infant death rate for infants of AI/AN mothers was 8.47 per 1000 live births compared with a non-Hispanic White rate of 5.33. 7 AI/AN children aged 1 to 19 years also had higher death rates than the overall US rate for children of all races. 4,8 Additionally, data available through the Indian Health Service (IHS) suggested regional differences in AI/AN infant and pediatric mortality patterns. 9 Racial misclassification has been estimated to underreport AI/AN death rates. 10 A recent linkage between the National Vital Statistics System (NVSS) mortality data and the IHS patient registration file reduced AI/AN racial misclassification in death records. 10 We took advantage of this novel data to better describe overall and regional AI/AN infant and pediatric death rates and leading causes of death. Our analysis provides improved information that could be used to strengthen efforts to reduce racial and ethnic disparities in AI/AN infant and pediatric mortality.
