Trends in diarrhea-associated hospitalizations among American Indian and Alaska native children, 1980-1995

Objective. To describe trends in diarrhea-associated hospitalizations among American Indian and Alaska Native (AI/AN) children and to estimate the mor bidity 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-ass ociated 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 hospitalizati ons were reported among AI/AN children. The annual incidence of diarrhea-as sociated 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 da ys during 1980-1982 to 2 days during 1993-1995. Diarrhea-associated hospita lizations peaked during the winter months (October through March), especial ly 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 yea rs of the study (1980-1982), the rate of diarrhea-associated hospitalizatio ns 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 nationa l rate for infants. Conclusions. Diarrhea-associated hospitalization rates for AI/AN children h ave declined to a level similar to that of the national population. Rotavir us may be an important contributor to diarrheal morbidity among AI/AN child ren, underscoring the need for vaccines against this pathogen.