Indian Health Care Page: 89
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Some difficulties also arise from IHS's use of
the concept "clinical impression. " Clinical impres
sion refers to the diagnosis first suspected by the
examining physician at the initial visit; it may not
be the final diagnosis. This has several implica
tions for morbidity analyses based on APC data.
For example, IHS had used APC records to de
rive incidence of diseases considered "notifiable"
bthe U.S. Centers for Disease Control (e.g.,
measles, syphilis) and other communicable dis
eases recognized as important sources of morbid
ity in Indian communities (e. g., otitis media).
These data made it appear as if Indians were
suffering from notifiable and communicable dis
eases at a much greater rate than the U.S. all races
population, when in fact such incidence rates in
cluded mistaken, perhaps overcautious, diagno
ses. For example, a validity check of a count of
several hundred clinical impressions of measles
turned up only one actual case. For this reason,
IHS no longer publishes such information, al
though it can still be obtained from APC records
(58).
Comparisons With IHS Publications. For cer
tain statistical calculations (e. g., mortality rates
reported in the Chart Series Book published in
1984 and 1985) the IHS uses census counts of the
total American Indian and Alaska Native popu
lation residing in all reservation States, and the
total number of Indian deaths in those States, to
calculate national Indian death rates. In these
cases, the nonservice population (those who do
not reside in the geographic areas in which IHS
has responsibilities), are included in IHS's calcu
lations. IHS uses this method in order to be able
to compare current Indian health status with In
OVERVIEW OF HEALTH STATUS
Overall Indian health status relative to the
health of "U.S. all races" combined can be pre
sented in several ways: the age distribution of
deaths, differing causes of death, and differing
patterns of health care utilization. In this section
these health indicators are averaged for Indians
in all IHS service areas, and comparisons across
IHS services areas are made. Then, the health staCh. 4-Health Status of American Indians . 89
dian health status in 1955 (26), when IHS became
responsible for providing Indian health care but
IHS service areas as they are now known had not
been organized. However, the number of reser
vation States and the Indian population base has
changed considerably since 1955, so even these
comparisons should be made extremely cautiously.
At the time this report was being prepared, IHS
was conducting a congressionally requested study
of health parity which will include reports on
Indian mortality in individual IHS service areas,
including age adjusted mortality rates. OTA's
analysis has generally focused on IHS's service
population. Consequently, OTA's rates may dif
fer from some of IHS's published rates. These
differences are identified in the following analy
ses. In the 3 year period centered in 1981, there
were an estimated 15,321 deaths among IHS's
service population, and another 4,408 deaths in
the nonservice population.
Comparisons Over Time. A report published
in 1979 included mortality rates for IHS areas for
the 3 year periods centered in 1973 and 1976 (157),
but these were not adjusted for age and so were
not comparable to rates for the U.S. all races.
They are used in OTA's analysis to make rough
estimates of changes in health status over the dec
ade for which data on IHS areas are available.
These estimates should be interpreted cautiously
because of changes over time in a number of other
factors: the IHS population base (as a result of,
for example, "termination" and subsequent re
recognition of tribes as federally recognized);
changes in census methods; and changes in IHS
service area boundaries.tus of Indians in each IHS area is analyzed. These
analyses indicate that while there has been steady
improvement, in almost every IHS area and on
almost every health indicator, Indian health re
mains poorer than that of the U.S. population in
general. Further, there appear to be significant
differences in health care utilization, which may
be indicators of unmet need.
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United States. Congress. Office of Technology Assessment. Indian Health Care, report, April 1986; [Washington D.C.]. (https://digital.library.unt.edu/ark:/67531/metadc39610/m1/94/: accessed April 24, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.