Spatial Epidemiology of Alcohol‐ and Drug‐Related Health Problems Among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012. (30th January 2018)

• Record Type: Journal Article
• Authors: Ponicki, William R.; Henderson, Jeffrey A.; Gaidus, Andrew; Gruenewald, Paul J.; Lee, Juliet P.; Moore, Roland S.; Davids, Sharice; Tilsen, Nick
• Is Part Of: Alcoholism. Volume 42:Number 3(2018)
• Page Start: 578
• Page End: 588
• Publication Date: 2018-01-30
• Subjects: Alcohol -- Drugs -- Hospitalization -- American Indians -- Reservations; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13580
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: Despite high abstinence rates, American Indians experience elevated rates of many alcohol and other drug problems. American Indians also predominantly reside in poor and rural areas, which may explain some observed health disparities. We investigated whether geographic areas including reservations or large American Indian populations exhibited greater incidence of alcohol‐ and drug‐related hospitalizations. Methods: We obtained inpatient hospitalization records for 2 Northern Plain states (Nebraska and South Dakota) for the years 2007 to 2012. We constructed zip code counts for 10 categories of hospitalization with diagnoses or injury causation commonly associated with alcohol or drug use. We related these to community sociodemographic characteristics using Bayesian Poisson space–time regression models and examined associations with and without controls for whether each zip code was located within an American Indian reservation. Results: Controlling for other demographic and economic characteristics, zip codes with greater percentage of American Indians exhibited greater incidence for all 10 substance abuse‐related health outcomes (9 of 10 well supported); zip code areas within American Indian reservations had greater incidence of self‐inflicted injury and drug dependence and abuse, and reduced incidence of alcohol cirrhosis and prescription opioid poisoning. However, the analyses generally demonstrated no well‐supported differences in incidence associated with local residence percentages of American Indian versus African American. Conclusions: In our analyses, ethnicity or heredity alone did not account for alcohol‐ and drug‐related hospitalizations among Native populations. Aspects of social, economic, and political dimensions of Native lives must be considered in the etiology of alcohol‐ and drug‐related problems for rural‐dwelling indigenous peoples. Abstract : American Indian (AI) reservation areas in South Dakota and Nebraska experienced elevated hospitalization rates for many health problems previously linked to substance abuse. Holding other area characteristics constant, zip codes with average percent AI among reservations (67.7%) were predicted to have uniformly higher substance‐related hospitalization rates than they would with average non‐reservation percent AI (1.5%). This difference was well‐supported for 9 of 10 outcomes (as indicated by 95% credible intervals). A complex set of factors help to explain these differences.