Gonorrhea in Oklahoma Indian Gonorrhea in Oklahoma Indian Country:Country:Data and ChallengesData and Challenges

Cuyler Snider, MPHCuyler Snider, MPHEpidemiologistEpidemiologistOklahoma City Area Inter-Tribal Health BoardOklahoma City Area Inter-Tribal Health BoardTribal Epidemiology CenterTribal Epidemiology Center

Oklahoma American Indian population ≈ 273,000 (US Census 2000)

Challenges in Indian Challenges in Indian CountryCountry

Surveillance MethodsSurveillance Methods– State Health Department, not IHSState Health Department, not IHS– Fairly robust systemFairly robust system

High percentage of case ascertainmentHigh percentage of case ascertainment11

– Good amount of data, but…Good amount of data, but…

Challenges in Indian Challenges in Indian CountryCountry

Data (Tribes)Data (Tribes)– Request made to tribesRequest made to tribes– Most would require Data Sharing Most would require Data Sharing

AgreementsAgreements Difficult to accomplishDifficult to accomplish 2 out of 43 Tribes so far2 out of 43 Tribes so far Problems still remainProblems still remain

Challenges in Indian Challenges in Indian CountryCountry

Data (IHS)Data (IHS)– Limited access to the Resource and Limited access to the Resource and

Patient Management System (RPMS) and Patient Management System (RPMS) and Electronic Health Records (EHR)Electronic Health Records (EHR)

Request through IHS area officeRequest through IHS area office High urban populationHigh urban population

– Use of non-tribal clinicsUse of non-tribal clinics– Choice of raceChoice of race

Challenges in Indian Challenges in Indian CountryCountry

Data (State)Data (State)– Oklahoma State Department of Health (OSDH)Oklahoma State Department of Health (OSDH)

Self identified raceSelf identified race– Depends on locationDepends on location

MisclassificationMisclassification

MisclassificationMisclassification

Extent of misclassification on AI/AN’sExtent of misclassification on AI/AN’s– Studies show significant effectsStudies show significant effects

Usually WhiteUsually White

– Oklahoma STD study in AI/AN womenOklahoma STD study in AI/AN women11

Accounting for misclassificationAccounting for misclassification– Gonorrhea rates increased by 57%Gonorrhea rates increased by 57%– Chlamydia rates increased by 32%Chlamydia rates increased by 32%– Syphilis rates increased by 27%Syphilis rates increased by 27%

1. Thoroughman, Douglas A. (2002). Racial misclassification of American Indians in Oklahoma state surveillance data for sexually transmitted diseases, American Journal of Epidemiology, 155, (12), 1137-1141.

BarriersBarriers

Testing and TreatmentTesting and Treatment– Close social networksClose social networks

Indian Country is a “Small World”Indian Country is a “Small World”

– TransportationTransportation VehicleVehicle DistanceDistance

– TimeTime

Total Number of Gonorrhea and Chlamydia Infections for AI/AN's in Oklahoma

0

200

400

600

800

1000

1200

1400

1600

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Nu

mb

er o

f C

ases

Chlamydia

Gonorrhea

Comparison of Gonorrhea Rates in Oklahoma Whites and American Indians by Year

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rat

e p

er 1

00,0

00 p

op

ula

tio

n

AI Alone

White

Comparison of Chlamydia Rates in Oklahoma Whites and American Indians by Year

0

100

200

300

400

500

600

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate

per

100,0

00 p

op

ula

tio

n

AI Alone

White

Comparison of Gonorrhea Rates for Whites and American Indians in Oklahoma (2006)

56.40

124.96

0

20

40

60

80

100

120

140

White AI Alone

Race

Rat

e p

er 1

00,0

00 p

op

ula

tio

nComparison of Chlamydia Rates for Whites and American Indians in

Oklahoma (2006)

236.15

558.14

0

100

200

300

400

500

600

White AI Alone

Race

Rat

e p

er 1

00,0

00 p

op

ula

tio

n

The rates for Gonorrhea and Chlamydia in the Oklahoma AI/AN population are both over two times higher than the rates in the Oklahoma White population.

Next StepsNext Steps

Improved reportingImproved reporting Decrease misclassificationDecrease misclassification Culturally relevant preventionCulturally relevant prevention

Thank youThank you

Cuyler Snider, MPHCuyler Snider, MPHOklahoma City Area Inter-Tribal Health BoardOklahoma City Area Inter-Tribal Health Board

Tribal Epidemiology CenterTribal Epidemiology Centercuyler.snider@ihs.gov

405-951-6005405-951-6005