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Analysis of Prior Health System Contacts as a
Harbinger of Subsequent Fatal Injury in American Indians. Sanddal, T.L., Sanddal, N.D., Upchurch, J.D. & Esposito, T.J. (2005). Analysis of prior health system contacts as a harbinger of subsequent fatal injury in American Indians. Journal of Rural Health, 21(1), 65-69. Objective: To
identify and characterize any association between prior injury or
alcohol-related acute care contacts with the Indian Health Service (IHS)
and subsequent alcohol-related injury death that may suggest
opportunities for mitigation. Methods: All death
certificates involving American Indians who died from injury (ICD-9-E
800–999) in a rural IHS Area from 1/1/90-12/31/95 were obtained and
linked to IHS acute care facility records. Linkage to toxicology
reports performed on the deceased was also conducted. An association
was sought between IHS facility contacts occurring within 24 months of
a fatal injury. Deaths and prior IHS contacts were stratified by
alcohol use as a contributing factor. Non-parametric chi square
analyses were conducted. Results: Of the 526
injury deaths involving American Indians in the IHS Area studied, 411
(78%) were successfully linked. Of these, 256 (63%) had IHS facility
contact within the 24 months of death. Alcohol use at time of death (BAC
³0.0)
could be determined in 250 of 411 records (61%), 152 (59%) of these
had a prior IHS facility contact. No difference in alcohol use at time
of death between groups with and without prior IHS contact could be
determined overall (81% vs 74% p = .21). In those decedents who
had a prior IHS contact for injury without mention of alcohol, there
was no association with subsequent alcohol-related injury fatality (p
= .29). Prior injury visits with alcohol as a contributor were
also shown not to be associated with subsequent alcohol-related injury
fatality (p = .41). A statistically significant relationship
was found between previous visits for acute or chronic alcohol
treatment events and subsequent alcohol-related fatalities (p =
.01). Conclusion: In this population, prior health system contacts for any reason, including injury, do not appear to be associated with subsequent alcohol-related injury deaths unless alcohol use is a precipitating or co-morbid finding at the time of that contact. Based on these findings, injury prevention activities in the population studied should be initiated at the time of any health system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients using both traditional native and non-native materials and approaches. |
