Hospital resource utilization by American Indians/Alaska Natives for alcoholism and alcohol abuse

Previous work examining the issue of alcoholism and alcohol abuse among American Indians and Alaska Natives can be broadly categorized as either descriptions of the consumption patterns and behaviors of specific tribes or mortality studies, focusing on deaths due to alcoholism, alcohol abuse, chronic liver disease, or cirrhosis. A major shortcoming of previous studies has been that they have not looked at the burden this problem has imposed upon the system of health care delivery for this minority population. By using an International Classification of Diseases, Ninth Revision, Clinical Modification taxonomy of diagnostic codes developed by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the national Indian Health Service (IHS) inpatient database for direct and contract admissions, utilization patterns for 43 IHS facilities were investigated. The period of study was 1980-1988, and our case definition included any individual 14 years and older who had any mention upon discharge of an alcohol-related diagnosis (ARD). For the 9-year period under investigation, 43,302 adult inpatient admissions occurred at the 43 IHS facilities for ARD. These admissions accounted for an overall estimated per annum rate of 13.7% of the adult inpatient days. In addition, age and gender specific discharge rates for ARD were estimated and compared to reported ARD discharge rates of the United States civilian population prepared by the NIAAA using the National Hospital Discharge Survey over the period 1979-1988. In contrast, the IHS discharge rates for ARD were three times greater than reported ARD discharge rates for the United States civilian population.