Causes of Injury Hospitalizations Among the White Mountain Apache Tribe: A Needs Assessment

Introduction:

Injuries are the leading cause of death for American Indians ages 1-44 and the third leading cause of death overall. American Indians experience mortality and morbidity from injuries at disproportionate rates as compared to the overall US population. Fatality rates for motor vehicle occupant injuries are three times higher for American Indian children than for white and black children. Currently, there has been no systematic examination of available data which presents a barrier to defining and addressing the burden of injuries specific to the White Mountain Apache Tribe. A recent home-visiting trial with teen mothers by the Johns Hopkins Center for American Indian Health (supported by a NIDA grant) revealed some possible indicators of risk and intervention targets. For example, 40% of 103 participants had no working smoke alarms and only 11% reported having a fire escape plan. This needs assessment will inform the community’s intervention and prevention planning.

Methods:

We analyzed retrospective hospitalization data from the community’s one main healthcare facility. Through a data sharing agreement with the Indian Health Service, we obtained all injury-related hospitalization records from 2006 through 2012. Causes of injury were categorized using the CDC recommended External Cause-of-Injury (E-code) Matrices. Key word searches were conducted to capture information on alcohol/drug involvement, abuse, firearms, and bites. Descriptive statistics are presented.

Results:

The data contained information on 55,024 hospitalizations for 14,505 patients. Records with missing data for visit date (n=9; <1%), cause of injury (7,047; 13%), and CDC injury category 2,860; 5%) were excluded, leaving a total of 45,110 visits for 13,739 patients for analysis. The injury rate (496.0 per 1,000) is four times the national rate of (126.3 per 1,000). Falls were the most common injury (8,593; 19%), followed by struck by or against (8,236; 18%), overexertion (5,564; 12%), cut or pierce (4,453; 10%), and natural or environment (4,429 (10%). Unintentional, intentional, and suicidal injuries accounted for 78%, 13%, and 1% of injuries. Alcohol was noted in 11% injuries, opiates in <1%, abuse in 6%, animal/insect bites in 10%, firearms in <1%, motor vehicles in 2.5%.

Conclusions:

These findings have significant implications for public health prevention efforts at the hospital and local policy level. Improvements in coding at the hospital level are imperative for understanding and preventing injuries. Policies could be enacted to curb bites and alcohol/drug related injuries. Environmental and family level interventions may be beneficial in reducing morbidity and mortality due to injuries in children.