# Presentation: 581046

## Tracking American Indians and Alaska Natives: IHS Data Issues Associated with Measuring HP2010 Objectives

**Colleen M. Ryan, M.P.H.**
**Jo Ann Pappalardo**
**Karen Carver, Ph.D.**
**Edna L. Paisano**
**Phillip L. Smith, M.D.**
**INDIAN HEALTH SERVICE**

## OVERVIEW

- Background on IHS
- Healthy People 2000/2010 at IHS
- IHS data sources tracking HP objectives
- IHS National Patient Information Reporting System (NPIRS)
- Vital Statistics (NCHS/CDC)
- Data Issues related to IHS data sources
- Adjusting for misreporting of AI/AN race on death certificate
- 2000 Census population
- ICD-9/ICD-10
- Age adjustment to 2000 standard
- Comparability: IHS Area estimates vs. all AI/AN population
- HP2010 plans at IHS – Tracking HP2010 Objectives

## IHS - BACKGROUND

- IHS strives to provide high-quality, comprehensive, culturally appropriate personal and public health services to all American Indians and Alaska Natives
- Members of federally recognized Indian tribes and their descendants are eligible for services provided by the IHS
- IHS is an agency within the Department of Health and Human Services that operates a comprehensive health service delivery system for approximately 1.6 million of the nation's estimated 2.6 million American Indians and Alaska Natives**  **

## 12 IHS Service Areas

## Office of Program Supportfor Headquarters and the 12 IHS Service Areas

- Divisions
- Planning and Evaluation
- Research Programs
- Epidemiology
- Program Statistics

- Major Responsibilities
- Data
- IHS National Patient Information Reporting System (NPIRS)
- Vital Statistics (NCHS/CDC)
- Surveillance
*Regional Differences*
*Trends*
- Disparities
- NCVHS
- NHDR
- Other HHS Initiatives
- Healthy People
- GPRA
- Strategic Plan

## IHS Data

- National Patient Information Reporting System (NPIRS)
- Users of IHS services: over 1.3 million eligible AI/ANs had visits in the past 3 years
- Service population- AI/AN residing in or near reservation areas where IHS facilities are available- is approximately 1.6 million
- Data are collected on each encounter made by eligible AI/AN
- The population served by IHS is estimated to be 60% of total AI/AN population (1.6 million of the estimated 2.6 million AI/ANs)
- Vital Events Data
- 	National Vital Statistics System, NCHS/CDC (NVSS)
- IHS Area and service unit codes are added
- Rates are calculated by adjusting for misreporting of AI/AN race on death certificate
*NOTE:** **	**IHS does not currently support any annual or periodic **	**surveys that could monitor health behavior of the total IHS **	**population it serves*

## Current Data Issues

**Misreporting of AI/AN race on death certificate and adjustment to mortality rates**
- Applying adjustment factors to correct for the 1.2% - 30.4% misreported AI/AN deaths
**2000 Census population **
- impact of multi-race on AI/AN population
**ICD-9/ICD-10 **
- Implementation using 3-year rates
- HP2010 Baselines will be recalculated using comparability ratios provided by NCHS
**Age adjustment to 2000 standard**
- Recalculating past years for trend data
**Comparability: IHS AI/AN estimates vs. “all” U.S. AI/AN population**
- IHS data are representative of AI/ANs being served in IHS areas only (~60% of all self-identified AI/ANs nationwide)

## Healthy People 2000 and IHS

- IHS produces a report *“****Tracking Regional Health Status Objectives****”*
- IHS produced *“****Statistical Notes****”* to disseminate among the 12 IHS Areas to outline the operational definitions of key Healthy People 2000 Objectives for AI/ANs

## Healthy People 2000 Objectives Tracked by IHS

- Alcohol-related motor vehicle crashes
- Breast cancer mortality
- Cancer (all sites) mortality
- Cervical cancer mortality
- COPD mortality
- Cirrhosis mortality
- Colorectal cancer mortality
- Coronary heart disease mortality
- Diabetes mortality
- Drug-related mortality

- Homicide
- Infant mortality
- Lung cancer mortality
- Maternal mortality
- Pneumonia and influenza mortality
- Stroke mortality
- Suicide
- Teen pregnancy
- Prenatal care in 1st trimester
- Unintentional injuries mortality

## Healthy People 2000 Final Assessment

- Final updates to measures tracked in Healthy People 2000
- Introduction to changes in indicators for Healthy People 2010 (Data Issues)
- Introduction to additional measures from HP2010 Objectives

## Select HP2010 Objectives and their Baseline Data, 1996-1998

- Suicide deaths
- Unintentional injury deaths
- Diabetes deaths
- Cirrhosis deaths
- Homicide deaths

- NOTE: Data are adjusted for the misreporting of race on the death certificate and are age-adjusted to the 2000 standard population

## HP2010 Indicator Example 1:

**11.3**

**12.6**

**19.2**

## HP2010 Indicator Example 2:

**35.0**

**59.9**

**101.4**

## HP2010 Indicator Example 3:

**75.0**

**107.0**

**82.4**

## HP2010 Indicator Example 4:

**9.5**

**25.9**

**43.5**

## HP2010 Indicator Example 5

**6.5**

**9.1**

**13.6**

## List of HP2010 indicators to be tracked by IHS(Mortality and Natality)

| 3-1 | Overall cancer deaths | 15-32 | Homicide deaths |
| --- | --- | --- | --- |
| 3-2 | Lung cancer deaths | 18-1 | Suicide deaths |
| 3-3 | Female breast cancer deaths | 16-1c | Infant deaths |
| 3-4 | Cervical cancer deaths | 16-1h | Sudden infant death syndrome (SIDS) |
| 3-5 | Colorectal cancer deaths | 16-4 | Maternal deaths |
| 5-5 | Diabetes deaths (underlying cause of death) | 16-6a | Prenatal care in 1st trimester |
| 5-6 | Diabetes-related deaths (underlying or multiple cause of death) | 16-10a | Low birth weight (LBW).  |
| 9-7       | Adolescent pregnancy | 24-10 | COPD deaths |
| 12-1 | Coronary heart disease deaths | 26-1a | Alcohol-related motor vehicle crash deaths |
| 12-7 | Stroke deaths | 26-2 | Cirrhosis deaths |
| 15-13 | Unintentional injury deaths |  |  |

## List of HP2010 indicators to be tracked by IHS(Patient Care- National Patient Information Reporting System)

| 1-9a | Pediatric asthma hospitalizations |
| --- | --- |
| 1-9b | Uncontrolled diabetes hospitalizations |
| 5-10 | Lower extremity amputations |
| 5-12 | Annual HbA1c measurement |
| 5-13 | Annual dilated eye exam |
| 5-14 | Annual foot exam |
| 12-6 | Congestive heart failure hospitalizations |
| 24-2 | Asthma hospitalizations |

- NOTE: Baseline data will use 2001 utilization data and will be based on the 1999-2001 IHS user population

## Summary

**IHS measures the healthcare for ~60% AI/ANs**
- IHS does not measure “all” U.S. AI/ANs that are identified through the US Census, only those AI/ANs in federally recognized tribes that are eligible for IHS services
- The IHS AI/AN population exhibits many disparities when compared against the overall US rate, and sometimes even with the “all” U.S. AI/AN rate
**IHS adjusts for the misreporting of AI/AN race on death certificate in its mortality rates**
- New adjustments will be applied at the completion of the most recent study to determine the CURRENT extent of misreporting (due to be completed in 2004)
**IHS mortality measures will be 3-year estimates beginning with 1996-1998.  **
- Baselines will be recalculated with NCHS ICD-9/ICD-10 comparability ratios when first data update occurs (1999-2001)
**Patient utilization-related objectives will start with 2001 baseline data**

## Contact Information

**Colleen M. Ryan**
**Health Statistician**
**Division of Program Statistics**
**OPS/OPH/IHS**
**12300 Twinbrook Parkway  **
**Suite 450**
**Rockville MD 20852**
**301-443-9143  Phone**
**301-443-4087  Fax**
- _[cryan@hqe.ihs.gov](mailto:cryan@hqe.ihs.gov)__  E-mail_

**IHS Home Page:****   http://www.ihs.gov**

**http://www.ihs.gov/NonMedicalPrograms/IHS_Stats/index.asp**

- For Program Statistics Home Page: