Racial disparities in pediatric injury hospitalization rates in a rural state

Purpose:  South Dakota has a high American Indian (AI) population with some of the country’s poorest reservations and highest AI morbidity and mortality rates.  The purpose of this analysis was to compare data on injury hospitalization rates from 2009-2013 among white and American Indian populations.  Injuries serious enough to result in hospitalization are costly in terms of human suffering and healthcare resources. 

Methods:  Injury rates were based on hospital discharge data (SD, 2009-2013) and diagnoses were coded according to ICD-9-CM codes (800-999). 

Results:  Injury hospitalization rates in 0-19 year olds increased from 21.9 to 31.2 per 10,000 between 2009 and 2013.  Hospitalization rates of AI children were twice that of White children between 0-14 years (29.4/10,000 vs. 12.7/10,000) and three times higher for ages 15-19 years (112.9/10,000 vs. 39.1/10,000).  Unintentional and suicide-related injuries were greater among AI children (26.2/10,000 & 15.6/10,000) than White children (13.2/10,000 & 5.2/10,000).  Falls were the leading cause of hospitalization for AI and White children aged <10 years (7.3/10,000 vs. 3.4/10,000), while poisoning was the leading cause for AI and White children 10-19 years (24.5/10,000 vs. 9.3/10,000).  Primary nature of injuries was fractures among both AI and White children aged 0-19 years (41.5% of hospitalizations) resulting primarily from unintentional injuries, with system-wide/late effects resulting from attempted suicide being second (30.6%).

Conclusions:  South Dakota American Indian children have disproportionately higher hospitalization rates due to injuries.  Knowing types of injuries requiring hospitalization will allow public health professionals to more efficiently target their efforts to prevent injuries.