Indian Health Status Collaborative
started in 2003
1. Tribal Health Board
California Rural Indian Health Board (CRIHB)
2. Indian Health Service (IHS) Area Office
California Area Office
3. State Department of Health Services
California Center for Health Statistics
4. University
PublicPublic-private Partnership to establish
a Public Health Surveillance System for AIAN
AI / AN in California:
Large Census Population
AI / AN:
Bridged
Estimate
All
472,692
Not
Hispanic
225,265
Hispanic
247,427
University of California San Francisco
1. California Center for Health Statistics
concerned about AIAN statistics
• Low Population Density AI / AN
– 1.6% of state population
– 4.3% is largest portion of any county
population
• High Racial Misclassification of AI / AN
– 30% to 70% depending on data type
* US Census 2000, Bridged Estimate Report 2003
Example:
California Mortality Rate for AI / AN
RACE
(non-Hispanics)
Age-Adjusted
RATE*
White
804.5
AI / AN
517.0
Black
1,079.7
Asian / Pac Isl.
506.2
AI / AN in Indian Health Service:
User Population
Calif
2000
2001
2002
2003
2004
2005
Users 65,299 66,617 67,266 69,238 71,696 75,195
* Indian Health Service
* Year 2000 Rate per 100,000 people, Adjusted with Year 2000 Standard Million Population
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2. Tribal Health Board in California
concerned about no AIAN data
Tribal Health Programs
(THP)
• Inform IHS funding allocation process
Service Areas in
– Uses mortality rates by cause (5)
– Perception that CA AIAN are healthier
37 of 58 counties
• Inform Disparities reduction efforts
Tribally owned and operated,
– Perception that CA AIAN had no disparities
Mainly IHS Funded
• Advocate for fair treatment
– Evaluate health impact of disparities in funding
of California THP
The Collaborative Links
IHS Data to State Data
IHS data identifies AIAN which is then
linked to state data bases
• Use IHS Active User Population data to
identify AIAN
AIAN Active Users
to Death Certificates
to Hospital Discharges
to Medicaid
to Birth Certificates
to Cancer Registry
(SEER)
to AIDS Registry
– Validated Social Security Number (to link)
– Other Demographic fields to improve linkage
• Link to state health data bases
– Deterministic linkage (SSN only)
– Probabilistic linkage
• Obtain comparable data for Whites
Racial Misclassification in State Data
California
Percent of Records
Death Certificates
26%
Hospital Discharges
61%
Medicaid
Birth Certificates
Cancer Registry (SEER)
AIDS Cases
Effect of Racial Misclassification on
the Disparity in Death Rates
Not Determined
AI / AN
nonHispanics*
White
nonHispanics
State data
517
805
IHS-State
Linked data
1035
858
Rate Ratio
[95% C.I.]
0.64
23%
In Progress
Not Determined
1.21
[1.13,1.29]
2
Hospitalization Disparity Rate Ratios
by Cause for THP Service Areas
•
•
•
•
•
•
•
Diabetes
Cardiovascular Disease
Asthma
Tobacco
Alcohol & Drug
Cancer
Preventable
Disparities in Hospitalization Rate
Ratios by THP Service Area
2.50
2.00
1.50
1.00
0.50
0.00
H
Major Factors in Success
• Needs of all three groups are served
• Long-term commitment (took 5 years)
– No turnover in major players
• Consistent commitment
– Everyone showed up every time to deal with IRB
issues
• Follow-through
– Findings used in testimony, reports and journal
articles produced change in perception and funds
V
N
D
L
A
Q
K
U
E
J
B
O
W
I
P
F
R
C
G
T
M
S
X
Thanks to Collaborative Members:
‹ California Rural Indian
Health Board (CRIHB)
‹ California Area Office
the Indian Health
services (IHS)
of
‹ California state Center for
Health Statistics (CHS)
‹ University of California
San Francisco (UCSF),
Institute for Health Policy
Studies
• James Crouch
• Margo Kerrigan
• James Sutocky
• Carol Korenbrot
• Chi Kao
• Sara Ehlers
UC Berkeley:
• Karen Garcia*
• Sarah Johnson
• Matthew Pearn
• Sharon Lee
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