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An Analysis of Pediatric Mortality Rates in Navajo County, Arizona

An Analysis of Pediatric Mortality Rates in Navajo County, Arizona. Wade Kartchner, MD, MPH Director, Navajo County Public Health Services District. Navajo County Demographics. County population-111,399 (2006 est.)

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An Analysis of Pediatric Mortality Rates in Navajo County, Arizona

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  1. An Analysis of Pediatric Mortality Rates in Navajo County, Arizona Wade Kartchner, MD, MPH Director, Navajo County Public Health Services District

  2. Navajo County Demographics County population-111,399 (2006 est.) Contains a large portion of the Navajo Nation, as well as a large majority of the Hopi tribe and the White Mountain Apache tribe Native Americans represent 46.4% of the county population

  3. Native American Reservations in Navajo county

  4. Arizona Child Fatality Review Program • Impetus for this study • Founded in 1993 • Consists of locally developed teams in counties throughout the state. • Goal is to reduce preventable child fatalities as it: • Reviews each child fatality and recommends legislation and public policy changes

  5. Navajo County Study • Data derived from Navajo County’s local Child Fatality Review Team • Observational, population-based • Deaths reviewed from January 1998 to December 2006 • Pediatric mortality rates for Navajo, Hopi, White Mountain tribes, and non-tribal areas calculated using the estimated 2002 population (the midpoint of the study) and compared with each other and the overall county rate

  6. Navajo County Study • Used the National Vital Statistics method of determining confidence intervals for mortality rates when the number of deaths is not large (fewer than 100) • When the resultant 95% confidence intervals do not overlap, then the difference is considered to be statistically significant at the 0.05 level.* • *National Vital Statistics Reports, Vol. 55 Number 19, August 21, 2007, p.116, 117.

  7. Navajo County pediatric deaths by residence and gender, 1998-2006

  8. Mean pediatric mortality rates in Navajo County, Arizona by tribe/non-tribal areas, 1998-2006 *p < 0.05 compared to all other subgroups, except the Hopi Tribe

  9. Mean pediatric mortality rates in Navajo County, Arizona by tribe/non-tribal areas and gender, 1998-2006 *p< 0.05, compared to all other male subgroups. ** p< 0.05 compared to all other female subgroups except for the Hopi Tribe.

  10. Health Disparities • Health disparities between Native Americans and non-Native Americans exist • Reasons may be multifactorial*: -Racial discrimination -Limited access to health services -Poor access to health insurance -Insufficient federal funding -Quality of care -Availability of culturally competent care -Poverty and lack of education -Behavior or lifestyle choices *“Broken Promises: Evaluating the Native American Health Care System”, September 2004 report by the United States Commission on Civil Rights at http://www.usccr.gov/pubs/nahealth/nabroken.pdf.

  11. Navajo County disparities • The three tribes live in relative close proximity to each other • Share many of the same problems and similar health care systems and delivery • Pediatric mortality rates in one tribe significantly different than the others • Why?

  12. Further investigations • Age stratification (problems with low numbers) • Preventable vs. non-preventable (Arizona CFRP has this data available) • Are there differences between the groups regarding preventability? • Might point to group differences that relate to specific behavioral or societal causes existing within the various tribes that lead to this disparity

  13. Questions?

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