1. Gonorrhea in Oklahoma Indian Country: Data and Challenges Cuyler Snider, MPH Epidemiologist Oklahoma City Area Inter-Tribal Health Board Tribal Epidemiology Center

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

3. Challenges in Indian Country Surveillance Methods Surveillance Methods –State Health Department, not IHS –Fairly robust system High percentage of case ascertainment 1 High percentage of case ascertainment 1 –Good amount of data, but…

4. Challenges in Indian Country Data (Tribes) Data (Tribes) –Request made to tribes –Most would require Data Sharing Agreements Difficult to accomplish Difficult to accomplish 2 out of 43 Tribes so far 2 out of 43 Tribes so far Problems still remain Problems still remain

5. Challenges in Indian Country Data (IHS) Data (IHS) –Limited access to the Resource and Patient Management System (RPMS) and Electronic Health Records (EHR) Request through IHS area office Request through IHS area office High urban population High urban population –Use of non-tribal clinics –Choice of race

6. Challenges in Indian Country Data (State) Data (State) –Oklahoma State Department of Health (OSDH) Self identified race Self identified race –Depends on location Misclassification Misclassification

7. Misclassification Extent of misclassification on AI/AN’s Extent of misclassification on AI/AN’s –Studies show significant effects Usually White Usually White –Oklahoma STD study in AI/AN women 1 Accounting for misclassification Accounting for misclassification –Gonorrhea rates increased by 57% –Chlamydia rates increased by 32% –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.

8. Barriers Testing and Treatment Testing and Treatment –Close social networks Indian Country is a “Small World” Indian Country is a “Small World” –Transportation Vehicle Vehicle Distance Distance –Time

12. 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.

13. Next Steps Improved reporting Improved reporting Decrease misclassification Decrease misclassification Culturally relevant prevention Culturally relevant prevention

14. Thank you Cuyler Snider, MPH Oklahoma City Area Inter-Tribal Health Board Tribal Epidemiology Center cuyler.snider@ihs.gov 405-951-6005