Pediatric Rheumatology Online Journal → August 2003 → Epidemiology - International Studies → Abstract #183

RHEUMATIC DISEASE IN CHILDREN AND ADOLESCENTS IN TWO INDIAN HEALTH SERVICE USER POPULATIONS

J. N. Jarvis,¹ J. Mauldin,¹ B. Fishinghawk,¹ G. Solomon,¹ D. Jeanotte.²

¹Pediatric Rheumatology Research, University of Oklahoma College of Medicine, Oklahoma City, OK; ²Billings Area Indian Health Service, Billings, MT

Rationale: As a group, rheumatic diseases are among the most common chronic disease conditions affecting children. However, reliable prevalence data in the United States have been difficult to acquire, in part because of the decentralized system of health care delivery in this country. However, the Indian Health Service (I.H.S.) represents a notable exception to that rule, and is, arguably, the only functioning public health delivery system in the U.S. Because of the existence of a population-wide database and the reported high prevalence rates of rheumatic diseases in Native American adults, we used I.H.S. patient registration databases to develop crude prevalence rates for specific childhood-onset rheumatic diseases in the I.H.S. user population.
Methods: We used International Classification of Diseases-9 (ICD-9) codes to search two I.H.S. patient registration databases over the years 1998-2000, searching for individuals 19 years of age or younger with specific ICD-9-specified diagnoses. Crude estimates for disease prevalence were made based on the number of individuals identified with these diagnoses within the database.
Results: Rheumatoid arthritis (RA) / juvenile rheumatoid arthritis (JRA) was the most frequent diagnosis given. The prevalence rate for JRA in the Oklahoma City Area was estimated as 53 per 100,000 individuals at risk, while in the Billings Area, the estimated prevalence was nearly twice that, at 115 per 100,000. While these rates are on the same order of magnitude as rates described in other North American and European populations, they are considerably higher than those reported in the most recent European studies. Small numbers of patients with systemic lupus erythematosus, juvenile dermatomysositis, and systemic sclerosis were also identified, but in numbers considerably higher than would be expected.
Conclusion - Childhood rheumatic diseases represent an important, though unrecognized, chronic health challenge within the American Indian population living in the United States.