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Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State
  1. Megan J Hoopes1,
  2. Jenine Dankovchik1,
  3. Thomas Weiser2,
  4. Tabitha Cheng3,
  5. Kristyn Bigback1,
  6. Elizabeth S Knaster4,
  7. David E Sugerman5
  1. 1Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, Oregon, USA
  2. 2Portland Area Indian Health Service and Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, Oregon, USA
  3. 3Division of Scientific Education and Professional Development, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  4. 4Urban Indian Health Institute, Seattle Indian Health Board, Seattle, Washington, USA
  5. 5National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Jenine Dankovchik, Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR 97201, USA; jdankovchik{at}npaihb.org

Abstract

Background The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population.

Methods We performed probabilistic record linkage between the Washington Trauma Registry (2005–2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality.

Results Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, p<0.001) and more commonly male (66.5% vs 61.2%, p<0.001). AI/AN experienced more intentional injuries (suicide or homicide: 20.1% vs 6.7%, p<0.001), a higher proportion of severe traumatic brain injury (20.7% vs 16.8%, p=0.004) and were less likely than caucasians to use safety equipment such as seat belts/airbags (53.9% vs 76.7%, p<0.001). ISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58).

Conclusions Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide.

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