Racial Misclassification and Disparities in Neonatal Abstinence Syndrome Among American Indians and Alaska Natives.

Objectives: Maternal substance misuse can result in neonatal abstinence syndrome (NAS), a drug withdrawal process in newborns exposed in utero to drugs. This study aimed to examine the effect of racial misclassification of American Indians and Alaska Natives (AI/AN) on rates of NAS in two hospital discharge datasets in the Pacific Northwest.

Methods: We conducted probabilistic record linkages between the Northwest Tribal Registry and Oregon and Washington hospital discharge datasets to correct racial misclassification of AI/AN people.

Hepatitis C-Related Mortality Among American Indian/Alaska Native Persons in the Northwestern United States, 2006-2012.

Objective: American Indian and Alaska Native (AI/AN) persons are commonly misclassified in epidemiologic and administrative data sets. The race-corrected hepatitis C virus (HCV)-related mortality rate among AI/AN persons in the Northwest United States (Idaho, Oregon, and Washington State) is unknown. We quantified the disparity in HCV-related mortality between AI/AN persons and non-Hispanic white (NHW) persons in the Northwest during 2006-2012 after correcting misclassified AI/AN race.

An Evaluation of Hepatitis C Virus Telehealth Services Serving Tribal Communities: Patterns of Usage, Evolving Needs, and Barriers.

Introduction: American Indian/Alaska Native (AI/AN) populations are disproportionately affected by chronic hepatitis C virus (HCV) infection. Federal facilities of the Indian Health Service, in conjunction with Tribally operated and Urban Indian (I/T/U) health care facilities, serve an estimated 2.2 million AI/AN patients.

Identification of American Indians and Alaska Natives in Public Health Data Sets: A Comparison Using Linkage-Corrected Washington State Death Certificates.

Context: Efforts to address disparities experienced by American Indians/Alaska Natives (AI/ANs) have been hampered by a lack of accurate and timely health data. One challenge to obtaining accurate data is determining who "counts" as AI/AN in health and administrative data sets.

Objective: To compare the effects of definition and misclassification of AI/AN on estimates of all-cause and cause-specific mortality for AI/AN in Washington during 2015-2016.

Evaluation of an adult immunization composite measure in the Indian Health Service.

Background: Government agencies, healthcare accreditation bodies and quality improvement organizations support the development of new quality measures. Composite quality measures use more than one measure to develop a broader assessment of healthcare system function. Currently, no composite measures for adult immunization coverage exist.

American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program.

Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon.

Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening.

Background: Whether patient navigation improves outcomes for patients with comorbidities is unknown. The aims of this study were to determine the effect of comorbidities on the time to diagnostic resolution after an abnormal cancer screening test and to examine whether patient navigation improves the timeliness and likelihood of diagnostic resolution for patients with comorbidities in comparison with no navigation.

Methods: A secondary analysis of comorbidity data collected by Patient Navigation Research Program sites using the Charlson Comorbidity Index (CCI) was conducted.

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening.

Objective: As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames.

Methods: Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL).

Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening: Data from the Patient Navigation Research Program.

Background: There is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs.

Methods: Secondary analyses of data from the intervention arms of the Patient Navigation Research Program were performed, which included navigated participants with abnormal breast and cervical cancer screening tests from 2007 to 2010. Independent variables were: 1) the number of unique barriers to care (0, 1, 2, or ≥3) documented during patient navigation encounters; and 2) the presence of socio-legal barriers originating from social policy (yes/no).

Impact of patient navigation in eliminating economic disparities in cancer care.

Background: Patient navigation may reduce cancer disparities associated with socioeconomic status (SES) and household factors. This study examined whether these factors were associated with delays in diagnostic resolution among patients with cancer screening abnormalities and whether patient navigation ameliorated these delays.

Methods: This study analyzed data from 5 of 10 centers of the National Cancer Institute's Patient Navigation Research Program, which collected SES and household data on employment, income, education, housing, marital status, and household composition.

Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State.

Background: The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population.

Methods: We performed probabilistic record linkage between the Washington Trauma Registry (2005-2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors.

Disparities in life expectancy of pacific northwest American Indians and Alaska natives: analysis of linkage-corrected life tables.

Objectives: American Indians and Alaska Natives (AI/ANs) experience a high burden of mortality and other disparities compared with the general population. Life tables are an important population health indicator; however, federal agencies have not produced life tables for AI/ANs, largely due to racial misclassification on death certificates. Our objective was to correct this misclassification and create life tables for AI/ANs who resided in the Pacific Northwest region of the U.

Colorectal cancer screening among American Indians in a Pacific Northwest tribe: Cowlitz Tribal BRFSS Project, 2009-2010.

Objectives: Colorectal cancer (CRC) screening is low among American Indians (AIs). We describe the demographics, health status, prevalence of modifiable CRC risk factors, and use of CRC screening modalities in a Pacific Northwest AI tribe.

Methods: We conducted a survey among Cowlitz tribal members using a Behavioral Risk Factor Surveillance System (BRFSS) questionnaire.

Racial misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area.

Objectives: We evaluated the racial misclassification of American Indians and Alaska Natives (AI/ANs) in cancer incidence and all-cause mortality data by Indian Health Service (IHS) Contract Health Service Delivery Area (CHSDA).

Methods: We evaluated data from 3 sources: IHS-National Vital Statistics System (NVSS), IHS-National Program of Cancer Registries (NPCR)/Surveillance, Epidemiology and End Results (SEER) program, and National Longitudinal Mortality Study (NLMS). We calculated, within each data source, the sensitivity and classification ratios by sex, IHS region, and urban-rural classification by CHSDA county.

Impact of patient navigation on cancer diagnostic resolution among Northwest Tribal communities.

The patient navigator model has not been widely implemented in American Indian/Alaska Native (AI/AN) communities, but may be effective in improving cancer outcomes for this population. Subjects were enrolled from eight clinics at Tribes throughout the Northwest (n = 1,187). Four clinics received navigation.

Trends and correlates of child passenger restraint use in 6 Northwest tribes: the Native Children Always Ride Safe (Native CARS) project.

Objectives: We compared proportions of children properly restrained in vehicles in 6 Northwest American Indian tribes in 2003 and 2009, and evaluated risks for improper restraint.

Methods: During spring 2009 we conducted a vehicle observation survey in Oregon, Washington, and Idaho tribal communities. We estimated the proportions of children riding properly restrained and evaluated correlates of improper restraint via log-binomial regression models for clustered data.

Regional differences and tribal use of American Indian/Alaska Native cancer data in the Pacific Northwest.

In the Pacific Northwest, cancer is a leading cause of morbidity and mortality for American Indians and Alaska Natives (AI/AN). Misclassification of AI/AN race in state cancer registries causes cancer burden to be underestimated. Furthermore, local-level data are rarely available to individual tribes for use in health assessment and program planning.

Including self-reported race to improve cancer surveillance data for American Indians and Alaska Natives in Washington state.

Background: American Indians and Alaska Natives (AI/AN) are frequently misclassified as another race in cancer surveillance systems, resulting in underestimated morbidity and mortality. Linkage methods with administrative records have been used to correct AI/AN misclassification, but AI/AN populations living in urban areas, and those who self-identify as AI/AN race, continue to be under-ascertained. The aim of this study was to evaluate racial misclassification in two cancer registries in Washington State using an urban AI/AN patient roster linked with a list of Indian Health Service (IHS) enrollees.

Measuring the health status gap for American Indians/Alaska Natives: getting closer to the truth.

Objectives: We compared the historical method of calculating cancer incidence rates with 2 new methods to determine which approach optimally estimates the burden of cancer among the Northwest American Indian/Alaska Native (AIAN) population.

Methods: The first method replicates the traditional way of calculating race-specific rates, and the 2 new methods use probabilistic record linkages to ascertain cancer cases. We indirectly adjusted all rates to the standard 2000 US population.

Effect of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates, 1989-1997.

Objectives: This study examined effects of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates.

Methods: Probabilistic record linkage were used to match the 1989-1997 state death files to the Northwest Tribal Registry.

Results: We identified matches for 2819 decedents, including 414 (14.