A strategy for reducing tuberculosis among Oglala Sioux Native Americans

Background: The Oglala Sioux people, who live on the second largest Native American reservation in the United States, the Pine Ridge Reservation in South Dakota, have a history of high rates of tuberculosis. Methods: To determine a strategy for reducing tuberculosis in this population, Pine Ridge Reservation tuberculosis cases since 1968 were analyzed. Diabetic patients were identified through chart reviews and characterized for tuberculosis status. Age-specific tuberculosis rates and age-specific relative risks (RRs) were calculated and compared with those of South Dakota excluding Pine Ridge. Results: Between 1968 and 1994, the RR for tuberculosis was 18.9 for a Pine Ridge Native American compared with rates for the rest of South Dakota. The age-specific RR was 65.7 for the Pine Ridge population 65 and older from 1985-1934. Tuberculin tests were positive in 70% of diabetic patients on the reservation. Diabetic patients comprise 23% of the population 45 and older at Pine Ridge. Fifty-five percent of all the tuberculosis disease in the 45 and older age group can be prevented by eliminating it in the diabetic population. Conclusions: A major stride toward reducing tuberculosis can be made by targeting high-risk groups such as diabetic patients, especially in a time of dwindling resources and personnel for tuberculosis control.