Wendy BrunnerMinnesota Department of HealthJune 13, 2011

Using Data from the Indian Health Service General Data Mart to Describe the Burden of American in Minnesota’s American Indian Population

MDH Asthma Program working on three projects with American Indian tribes in Minnesota• Sought data on asthma to assist in developing

programs and for program evaluation

Few sources of data are available to describe burden of asthma• Hospital discharge data does not include claims

from Indian Health Service (IHS) hospitals• Hospital discharge data does not include

race/ethnicity• Statewide surveys (e.g., BRFSS) do not sample

sufficient numbers to produce reliable estimates for this population

Background

American Indians in Minnesota• 11 tribes• 3 IHS facilities: Cass Lake

hospital, Red Lake hospital, White Earth health center• >39,000 American Indians

residing in Minnesota received health services at an IHS or Tribal facility in 2007-2009 (Bemidji Area IHS Headquarters User Population report)

Source: Bemidji Area IHS Office

• Covers users of tribal health care• Contains registration (demographics) and encounter data including office visits, hospitalizations, ED visits, and medication dispensing events • Data exported from facilities via RPMS or commercial software to IHS National Data Warehouse• Unique identifier links the registration and encounter tables• Authorized users include some Area Statistical Officers

Data Source: IHS General Data Mart

•Asthma prevalence criteria : “Any asthma” vs. “Persistent asthma”•Time window: 1 yr vs. 2 yr vs. 3 yr•Denominator: population of active users vs. IHS census-based estimate of service population

Asthma Query options

Asthma Prevalence Criteria

Meeting any of the following:

• ≥1 emergency department visit with a primary diagnosis of asthma

• ≥1 acute inpatient discharge with a primary diagnosis of asthma

• ≥1 outpatient visit with a primary or secondary diagnosis of asthma

• ≥2 asthma medication dispensing events

Meeting any of the following:

• ≥1 emergency department visit with a primary diagnosis of asthma

• ≥1 acute inpatient discharge with a primary diagnosis of asthma

• ≥4 outpatient visits with a primary or secondary diagnosis of asthma AND ≥2 asthma medication dispensing events

• ≥4 asthma medication dispensing events

“Any Asthma” “Persistent Asthma”

Asthma Queries1. Any asthma, 2009

2. Any asthma, 2008-2009

3. Any asthma, 2007-2009

4. Persistent asthma, 2009

5. Persistent asthma, 2008-2009

6. Persistent asthma, 2007-2009

Results: Denominators - I

2009 2008-2009 2007-2009

Age Group # % # % # %

0-4 4,244 11.8% 5,138 12.1% 6,049 12.7%

5-14 6,338 17.6% 7,400 17.5% 8,243 17.3%

15-34 11,514 32.0% 13,928 32.9% 15,888 33.3%

35-64 11,667 32.4% 13,391 31.6% 14,819 31.1%

65+ 2,274 6.3% 24,86 5.9% 2,668 5.6%

Total 36,037 42,343 47,667

Active Users of Tribal Health Care

Results: Denominators - II

2008-2009 Total Females Males

Age Group # % # % # %

0-4 5,138 12.1 2,469 11.2 2,669

13.2

5-14 7,400 17.5 3,649 16.5 3,751

18.5

15-34 13,928

32.9 7,411 33.6 6,517

32.1

35-64 13,391

31.6 7,131 32.3 6,260

30.9

65+ 2,486 5.9 1,397 6.3 1,089 5.4

Total 42,343 22,057

20,286

Active Users of Tribal Health Care

Demographics of active users of tribal health care vs. Minnesota

Results: Asthma definition comparison

Results: Time window comparison - I

Results: Time window comparison - II

“Any Asthma” definition, 2008-2009

Tribal Asthma Data Profile – page 1

Tribal Asthma Data Profile – page 2

Strengths and Limitations of Data SourceStrengths• Breadth of information available• Timeliness• Skilled and knowledgeable statistician to run queries

Limitations• Lack of direct access to the data• Dependent on IHS staff availability • Does not cover all American Indians living in Minnesota;

only users of tribal health care• Consistently picking up contract care?• Administrative prevalence comparability with survey data?

Next Steps• Regional data profiles• Tribal-level data profiles• Tribal-level queries (IHS area office needs written permission from tribal council to run queries of tribal-level data)• Asthma control measures: e.g., average # of quick reliever dispensing events per year, ratio of ED visits/clinic visits for asthma

Conclusion• IHS General Data Mart is a rich source of health information for American Indians living in Minnesota• Opportunity to collaborate with IHS staff and benefit from their knowledge of the data