Ectopic Pregnancy Among American Indian and Alaska Native Women, 2002–2009
- 240 Downloads
To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15–44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002–2009. We used 2002–2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15–44 years receiving care at IHS-affiliated facilities during 2002–2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15–19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35–39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1–2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002–2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.
KeywordsEctopic pregnancy North American Indians
The authors would like to thank Thomas A. Peterman, MD, MS (CDC, Atlanta, GA); Catherine L. Satterwhite, PhD, MSPH, MPH (University of Kansas School of Medicine, Wichita, KS); Jean Howe, MD, MPH (IHS, Shiprock, NM); and Suzanne Zane, DVM (CDC, Portland, OR) for their insightful review and expertise as this manuscript developed. We thank Barbara Strzelczyk (IHS), Diana Roberts (CDC), and Jason Mehal, MPH (CDC) for technical assistance, as well as the staff of the IHS National Patient Reporting System and the staff at the participating IHS, tribal, and urban Indian health care facilities.
- 5.Zane, S. B., Kieke, B. A., Kendrick, J. S., & Bruce, C. (2002). Surveillance in a time of changing health care practices: Estimating ectopic pregnancy incidence in the United States. MCH Journal, 6(4), 227–236.Google Scholar
- 7.Martin, J. A., Hamilton, B. E., Osterman, M. J. K., Curtin, S. C., & Mathews, T. J. (2013). Births: Final data for 2012. National Vital Statistics Reports, 62(9), 1–87.Google Scholar
- 9.CDC. (2011). Sexually transmitted disease surveillance (p. 2012). Atlanta, GA: US Dept. of Health and Human Services.Google Scholar
- 10.CDC. (2009). Trends in smoking before, during, and after pregnancy—Pregnancy risk assessment monitoring system (PRAMS), United States, 31 Sites, 2000–2005. MMWR, 58(SS04), 1–29.Google Scholar
- 11.CDC. (2010). Health characteristics of the American Indian and Alaska Native adult population: United States, 2004–2008. National Health Statistics Report, 20.Google Scholar
- 12.CDC. (2011). Vital signs: Current cigarette smoking among adults aged ≥18 years—United States, 2005–2010. MMWR, 60(35), 1207–1212.Google Scholar
- 14.CDC. (1995). Current trends ectopic pregnancy—United States, 1990–1992. MMWR, 44(03), 46–48.Google Scholar
- 15.Van Den Eeden, S. K., Shan, J., Bruce, C., & Glasser, M. (2005). Ectopic pregnancy rate and treatment utilization in a large managed care organization. ACOG, 105(5 Part 1), 1052–1057.Google Scholar
- 16.IHS. (2013). Basis for health services (factsheet). http://www.ihs.gov/newsroom/factsheets/basisforhealthservices. Accessed July 10, 2013.
- 17.IHS. (2013). IHS year 2013 profile (factsheet). http://www.ihs.gov/newsroom/factsheets/ihsyear2013profile/. Accessed July 20, 2013.
- 18.Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2010). Health characteristics of the American Indian or Alaska Native adult population: United States, 2004–2008 National Health Statistics Reports; No 20. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- 19.Indian Health Service. (2011). Direct/contract health service inpatient and outpatient visit data, fiscal years 1998–2010. Albuquerque, NM: Indian Health Service.Google Scholar
- 21.IHS. (2003). Regional differences in Indian health, 2000–2001. Rockville, MD: US Department of Health and Human Services, 2003.Google Scholar
- 22.IHS. (2009). Trends in Indian health, 2002–2003. Rockville, MD: US Department of Health and Human Services.Google Scholar
- 23.U.S. Public Health Service and Health Care Financing Administration. (2008). International classification of diseases, 9th revision, clinical modification (CD-ROM) (6th ed.). Washington, DC: U.S. Department of Health and Human Services.Google Scholar
- 24.Hoyert, D. L. (2007). Maternal mortality and related concepts. Vital and Health Statistics, 3(33), 1–13.Google Scholar
- 25.Kleinbaum, D. G., Kupper, L. L., Muller, K. E., & Nizam, A. (1998). Applied regression analysis and other multivariable methods (3rd ed.). Pacific Grove, CA: Duxbury Press.Google Scholar
- 26.Stulberg, D. B., Cain, L. R., Dahlquist, I., & Lauderdale, D. S. (2013). Ectopic pregnancy rates in the Medicaid population. American Journal of Obstetrics and Gynecology, 274(e1-274), e7.Google Scholar
- 29.IHS. (2013). Quality of IHS health care. http://www.ihs.gov/qualityofcare/index.cfm?module=chart&rpt_type=gpra&measure=18. Accessed July 24, 2013.
- 30.USDHHS. (2013). Healthy people 2020: Tobacco use. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=41. Accessed July 24, 2013.
- 36.CDC. (1983). Ectopic pregnancy surveillance. MMWR, 32(SS01), 19–21.Google Scholar
- 38.CDC. (1988). Ectopic pregnancy surveillance, United States, 1970–1985. MMWR, 37(SS-5), 9–18.Google Scholar
- 39.DC, C. (1990). Ectopic pregnancy surveillance, United States, 1970–1987. MMWR, 39(SS-4), 9–17.Google Scholar
- 40.CDC. (1993). Surveillance for ectopic pregnancy—United States, 1970–1989. MMWR, 42(SS-6), 73–85.Google Scholar