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Health Status of Urban American Indians and Alaska NativesA Population-Based Study
David C. Grossman, MD, MPH;
James W. Krieger, MD, MPH;
Jonathan R. Sugarman, MD, MPH;
Ralph A. Forquera, MPH
JAMA. 1994;271(11):845-850.
Abstract
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Objective.
—To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (AI/AN) population and compare it with urban whites and African Americans and with Al/ ANs living on or near rural reservations.
Design.
—Descriptive analysis of routinely reported data.
Setting.
—One metropolitan county and seven rural counties with reservation land in Washington State.
Subjects.
—All reported births, deaths, and cases of selected communicable diseases occurring in the eight counties from 1981 through 1990.
Main Outcome Measures.
—Low birth weight, infant mortality, and prevalence of risk factors for poor birth outcomes; age-specific and cause-specific mortality; rates of reported hepatitis A and hepatitis B, tuberculosis, and sexually transmitted diseases.
Results.
—Urban AI/ANs had a much higher rate of low birth weight compared with urban whites and rural AI/ANs and had a higher rate of infant mortality than urban whites. During the 10 years, urban AI/AN infant mortality rates increased from 9.6 per 1000 live births to 18.6 per 1000 live births compared with no trend among the other populations. Compared with rural AI/AN mothers, urban AI/AN mothers were 50% more likely to receive late or no prenatal care during pregnancy. Relative to urban whites, urban AI/AN risk factors for poor birth outcomes (delayed prenatal care, adolescent age, and use of tobacco and alcohol) were more common and closely resembled the prevalence among the African-American population except for a higher rate of alcohol use among AI/ANs. Compared with urban whites, urban AI/AN mortality rates were higher in every age group except the elderly. Differences between urban whites and AI/ANs were largest for injury- and alcohol-related deaths. All-cause mortality was lower among urban AI/ANs compared with rural AI/ANs and urban African Americans, although injury- and alcohol-related deaths were higher for AI/ANs. All communicable diseases studied were significantly (P<.05) more common among urban AI/ANs compared with whites. Tuberculosis rates were highest in the urban AI/AN group, but rates of sexually transmitted diseases were intermediate between urban whites and African Americans.
Conclusions.
—In this urban area, great disparities exist between the health of AI/ANs and whites across almost every health dimension we measured. No consistent pattern was found in the comparison of health indicators between urban and rural AI/ANs, though rural AI/ANs had lower rates of low birth weight and higher rates of timely prenatal care use. The poor health status of urban AI/AN people requires greater attention from federal, state, and local health authorities.
(JAMA. 1994;271:845-850)
Author Affiliations
From Harborview Medical Center (Drs Grossman and Krieger), the Departments of Pediatrics (Dr Grossman), Medicine (Dr Krieger), and Family Medicine (Dr Sugarman), School of Medicine, the Department of Health Services, School of Public Health (Dr Grossman), and the Native American Center of Excellence (Drs Grossman and Sugarman and Mr Forquera), University of Washington; the Seattle-King County Department of Public Health (Dr Krieger); the Division of Research, Evaluation, and Epidemiology, Portland Area Indian Health Service (Dr Sugarman); and the Seattle Indian Health Board (Mr Forquera), Seattle, Wash.
Footnotes
The views expressed in this article do not necessarily represent the views of the Nesholm Family Foundation or the Indian Health Service.
Reprint requests to Harborview Medical Center, 325 Ninth Ave, ZX-10, Seattle, WA 98104-2499 (Dr Grossman).
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