Lower respiratory tract infection hospitalizations among American Indian/Alaska Native adults, Indian Health Service and Alaska Region, 1998–2014

•Lower respiratory tract infection (LRTI) rates increased 26% among Alaska American Indian/Alaska Native adults, compared to a 38% decrease in non-Alaska American Indian/Alaska Native adults.•LRTI rates were higher in Alaska compared to non-Alaska.•The most common diagnosis associated with LRTI was pneumonia, followed by essential hypertension.•The median length of hospital stay was longer in Alaska compared to non-Alaska sites.•A lack of piped water and household crowding likely contributed to the high rates of LRTI.