Trends in Diarrhea-associated Hospitalizations Among American Indian and Alaska Native Children, 1980–1995

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Abstract
Objective. To describe trends in diarrhea- associated hospitalizations among American Indian and Alaska Native (AI/AN) children and to estimate the morbidity from rotavirus. Design. Retrospective analysis of Indian Health Service hospital discharge records. Patients. AI/AN children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record. Setting. Hospitals on or near US Indian reservations from 1980 through 1995. Results. During 1980 through 1995, 21 669 diarrhea-associated hospitalizations were reported among AI/AN children. The annual incidence of diarrhea-associated hospitalizations declined by 76% from 276 per 10 000 in 1980 to 65 per 10 000 in 1995. The median length of hospital stay decreased from 4 days during 1980–1982 to 2 days during 1993–1995. Diarrhea-associated hospitalizations peaked during the winter months (October through March), especially among children 4–35 months of age, with the peaks appearing first in the Southwest during October and moving to the East in March. In the early years of the study (1980–1982), the rate of diarrhea-associated hospitalizations among AI/AN children (236 per 10 000) was greater than the national rate (136 per 10 000). By the end of the study period (1993–1995), the rate for AI/AN children (71 per 10 000) was similar to the national rate (89 per 10 000), although the rate for AI/AN infants remained higher than the national rate for infants. Conclusions. Diarrhea-associated hospitalization rates for AI/AN children have declined to a level similar to that of the national population. Rotavirus may be an important contributor to diarrheal morbidity among AI/AN children, underscoring the need for vaccines against this pathogen.