RESUMEN
BACKGROUND: American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use. OBJECTIVE: We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans. METHODS: Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained. RESULTS: Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care. CONCLUSION: Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.
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Nativos Alasqueños , Accesibilidad a los Servicios de Salud , Indígenas Norteamericanos , Veteranos , Humanos , Femenino , Veteranos/estadística & datos numéricos , Veteranos/psicología , Estados Unidos , Nativos Alasqueños/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , United States Department of Veterans Affairs , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Adulto , Salud de la Mujer , Persona de Mediana Edad , Indio Americano o Nativo de Alaska/estadística & datos numéricos , Población Rural/estadística & datos numéricosRESUMEN
BACKGROUND: Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID-19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS: The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed-methods approach, integrating community-based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation-based schools. We conducted an analysis of caregiver self-report baseline data collected between August 2021 and May 2022. RESULTS: A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non-Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in-person, hybrid, and online-only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self-efficacy. CONCLUSIONS: This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts.
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COVID-19 , Cuidadores , Salud Mental , Humanos , COVID-19/epidemiología , Masculino , Femenino , Cuidadores/psicología , Niño , Adulto , Adolescente , Indígenas Norteamericanos/psicología , Indígenas Norteamericanos/estadística & datos numéricos , Instituciones Académicas , SARS-CoV-2 , Indio Americano o Nativo de Alaska/psicología , Indio Americano o Nativo de Alaska/estadística & datos numéricos , Nativos Alasqueños/psicología , Nativos Alasqueños/estadística & datos numéricos , Estudios Longitudinales , Persona de Mediana Edad , Factores Sociodemográficos , Resiliencia Psicológica , Adulto Joven , Estados Unidos/epidemiologíaAsunto(s)
Nativos Alasqueños , Indígenas Norteamericanos , Insuficiencia Renal Crónica , Humanos , Insuficiencia Renal Crónica/etnología , Insuficiencia Renal Crónica/epidemiología , Nativos Alasqueños/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
Importance: Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity. Objective: To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later. Design, Setting, and Participants: American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022. Exposures: Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment). Main Outcomes and Measures: Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures. Results: The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (ß = -1.21 [95% CI, -2.19 to -0.24]), anxiety (ß = -0.89 [95% CI, -1.76 to -0.03]), DBP (ß = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (ß = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (ß = 0.06 [95% CI, 0.01-0.11]) at follow-up. Conclusions and Relevance: This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.
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Nativos Alasqueños , Trastornos del Sueño-Vigilia , Humanos , Adolescente , Femenino , Masculino , Nativos Alasqueños/estadística & datos numéricos , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etnología , Población Urbana/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , California/epidemiología , Estudios de CohortesRESUMEN
OBJECTIVE: American Indian/Alaska Native (AI/AN) people have high rates of physical pain. Pain is understudied in urban-dwelling, AI/AN emerging adults, a group with unique sociocultural risk and protective factors. We explore associations between socioeconomic disadvantage, additional sociocultural factors, and pain among urban AI/AN emerging adults. METHODS: AI/AN participants aged 18-25 years ( N = 417) were recruited via social media. Regression models tested associations between socioeconomic disadvantage (income and ability to afford health care) and pain as well as additional sociocultural factors (discrimination, historical loss, cultural pride and belonging, visiting tribal lands) and pain. Multigroup regression models tested whether associations between sociocultural factors and pain differed between participants who were socioeconomically disadvantaged and those who were less disadvantaged. RESULTS: In the full sample, lower income ( b = 1.00-1.48, p < .05), inability to afford health care ( b = 1.00, p = .011), discrimination ( b = 0.12, p = .001), and historical loss ( b = 0.24, p = .006) were positively associated with pain, whereas visiting tribal lands was negatively associated with pain ( b = -0.86 to -0.42, p < .05). In the multigroup model, visiting tribal lands 31+ days was negatively associated with pain only among the less socioeconomically disadvantaged group ( b = -1.48, p < .001). CONCLUSIONS: Socioeconomic disadvantage may, in part, drive pain disparities among AI/AN emerging adults and act as a barrier to benefitting from visiting tribal lands. Results support a biopsychosocial approach to targeting pain in this population, including addressing socioeconomic challenges and developing culturally informed, strengths-based interventions.
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Nativos Alasqueños , Dolor , Factores Protectores , Población Urbana , Humanos , Adulto , Adulto Joven , Femenino , Masculino , Adolescente , Población Urbana/estadística & datos numéricos , Dolor/etnología , Dolor/epidemiología , Nativos Alasqueños/estadística & datos numéricos , Factores de Riesgo , Indígenas Norteamericanos/estadística & datos numéricos , Factores Socioeconómicos , Indio Americano o Nativo de Alaska/estadística & datos numéricosRESUMEN
BACKGROUND: While a major goal of community-based participatory research (CBPR) is to improve community health; it is unclear how to measure longstanding success of CBPR. OBJECTIVE: We sought to determine the impact of ongoing CBPR on cardiometabolic health of participating communities, including in people not directly participating in research. METHODS: We used linear mixed-effects modelling with electronic medical records from 2002 to 2012 from the Yukon-Kuskokwim Health Corporation, which provides health care to all Alaska Native people in southwestern Alaska, to compare rates of change in cardiometabolic risk factors between communities that did and did not participate in ongoing CBPR beginning in 2003. RESULTS: We analysed 1,262,035 medical records from 12,402 individuals from 10 study and 38 control communities. Blood pressure declined faster in study than in control communities: systolic blood pressure (0.04 mmHg/year; 95% confidence interval [CI]: 0.01, 0.08); diastolic blood pressure (DBP) (0.07 mmHg/year; 95% CI: 0.04, 0.09). Body mass index increased 0.04 units/year faster in study communities than in control communities (95% CI: 0.03, 0.05). More study visits were associated with faster reduction of DBP and triglyceride levels in study communities. CONCLUSIONS: Ongoing CBPR may improve overall cardiometabolic health in communities, perhaps by increasing engagement in health and advocacy.
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Investigación Participativa Basada en la Comunidad , Registros Electrónicos de Salud , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Registros Electrónicos de Salud/estadística & datos numéricos , Alaska/epidemiología , Presión Sanguínea , Factores de Riesgo Cardiometabólico , Nativos Alasqueños/estadística & datos numéricos , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Anciano , Adulto JovenRESUMEN
Many people with diabetes mellitus experience minimal or no complications. Our objective was to determine the proportion of Alaska Native people who experienced four major complications or mortality and to identify factors that may be associated with these outcomes. We used records in a diabetes registry and clinical and demographic variables in our analyses. We used logistic regression and Cox Proportional Hazards models to evaluate associations of these parameters with death and complications that occurred prior to 2013. The study included 591 Alaska Native people with non-type 1 diabetes mellitus, diagnosed between 1986 and 1992. Over 60% of people in this study remained free of four major diabetes-related complications for the remainder of life or throughout the approximately 20-year study period. Lower BMI, higher age at diagnosis of diabetes, and use of at least one diabetes medication were associated with death and a composite of four complications. A majority of Alaska Native people with DM had none of four major complications over a 20-year period. Lower BMI and use of diabetes medications were associated with higher hazard for some deleterious outcomes. This suggests that goals in care of elders should be carefully individualised. In addition, we discuss several programme factors that we believe contributed to favourable outcomes.
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Nativos Alasqueños , Complicaciones de la Diabetes , Diabetes Mellitus , Humanos , Alaska/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Nativos Alasqueños/estadística & datos numéricos , Anciano , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etnología , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/etnología , Adulto , Índice de Masa Corporal , Modelos de Riesgos Proporcionales , Modelos Logísticos , Factores de Edad , Adulto JovenRESUMEN
The Alaska Native Tribal Health Consortium (ANTHC) participated in the United States Centers for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP) from 2009 to 2015. We conducted a descriptive evaluation of ANTHC CRCCP demographics, quality measures, and clinical outcomes, including screening methods employed within the program and screening outcomes. There were 6981 program screenings completed, with the majority (81.3%) of people screened in the 50-75 year age group. Colonoscopy was the primary screening test used, accounting for 6704 (96.9%) of the screening tests. Quality of colonoscopy was high: adequate bowel preparation was reported in 98.2% of colonoscopies, cecal intubation rate was 98.9%, and the adenoma detection rate was 38.9%. A high proportion (58.9%) of colonoscopies had an initial finding of polyps or lesions suspicious for cancer; 41.2% of all colonoscopies had histological confirmation of either adenomatous polyps (40.6%) or cancer (0.5%). The ANTHC CRCCP successfully increased CRC screening among American Indian and Alaska Native peoples living in Alaska; this was achieved primarily through high-quality colonoscopy metrics. These data support a continued focus by the Alaska Native Tribal Health Consortium and its tribal health partners on increasing CRC screening and reducing cancer mortality among Alaska Native peoples.
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Nativos Alasqueños , Colonoscopía , Neoplasias Colorrectales , Detección Precoz del Cáncer , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alaska/epidemiología , Nativos Alasqueños/estadística & datos numéricos , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/etnología , Detección Precoz del Cáncer/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Non-Hispanic American Indian and Alaska Native (NH-AI/AN) people exhibit a disproportionate incidence of kidney cancer. Nationally aggregated data do not allow for a comprehensive description of regional disparities in kidney cancer incidence among NH-AI/AN communities. This study examined kidney cancer incidence rates and trends among NH-AI/AN compared with non-Hispanic White (NHW) populations by geographic region. METHODS: Using the United States Cancer Statistics American Indian and Alaska Native (AI/AN) Incidence Analytic Database, age-adjusted incidence rates (per 100,000) of kidney cancers for NH-AI/AN and NHW people for the years 2011 to 2020 combined using surveillance, epidemiology, and end Results (SEER)∗stat software. Analyses were restricted to non-Hispanic individuals living in purchased/referred care delivery area (PRCDA) counties. Average annual percent changes (AAPCs) and trends (1999-2019) were estimated using Joinpoint regression analyses. RESULTS: Rates of kidney cancer incidence were higher among NH-AI/AN compared with NHW persons in the United States overall and in five of six regions. Kidney cancer incidence rates also varied by region, sex, age, and stage of diagnosis. Between 1999 and 2019, trends in kidney cancer rates significantly increased among NH-AI/AN males (AAPC = 2.7%) and females (AAPC = 2.4%). The largest increases were observed for NH-AI/AN males and females aged less than 50 years and those diagnosed with localized-stage disease. CONCLUSIONS: Study findings highlight growing disparities in kidney cancer incidence rates between NH-AI/AN and NHW populations. IMPACT: Differences in geographic region, sex, and stage highlight the opportunities to decrease the prevalence of kidney cancer risk factors and improve access to preventive care.
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Nativos Alasqueños , Indígenas Norteamericanos , Neoplasias Renales , Humanos , Masculino , Nativos Alasqueños/estadística & datos numéricos , Femenino , Incidencia , Neoplasias Renales/epidemiología , Neoplasias Renales/etnología , Estados Unidos/epidemiología , Persona de Mediana Edad , Indígenas Norteamericanos/estadística & datos numéricos , Anciano , Adulto , Programa de VERF/estadística & datos numéricos , Indio Americano o Nativo de Alaska/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Persistent human papillomavirus (HPV) infection can cause anogenital and oropharyngeal cancers. Many HPV infections and HPV-associated cancers are vaccine-preventable. Studies suggest long-term persistence of vaccine-induced antibodies. However, data are limited among Alaska Native people. METHODS: During 2011-2014, we enrolled Alaska Native children aged 9-14 years who received a 3-dose series of quadrivalent HPV vaccine (4vHPV). We collected sera at 1 month and 1, 2, 3, and 5 years post-vaccination to evaluate trends in type-specific immunoglobulin G antibody concentrations for the 4vHPV types (HPV 6/11/16/18). RESULTS: All participants (N = 469) had detectable antibodies against all 4vHPV types at all timepoints post-vaccination. For all 4vHPV types, antibody levels peaked by 1 month post-vaccination and gradually declined in subsequent years. At 5 years post-vaccination, antibody levels were higher among children who received 4vHPV at a younger age. CONCLUSIONS: Alaska Native children maintained antibodies against all 4vHPV types at 5 years post-vaccination.
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Nativos Alasqueños , Anticuerpos Antivirales , Inmunogenicidad Vacunal , Infecciones por Papillomavirus , Humanos , Niño , Adolescente , Femenino , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/inmunología , Anticuerpos Antivirales/sangre , Masculino , Nativos Alasqueños/estadística & datos numéricos , Alaska , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18/inmunología , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18/administración & dosificación , Vacunación , Inmunoglobulina G/sangre , Vacunas contra Papillomavirus/inmunología , Vacunas contra Papillomavirus/administración & dosificaciónRESUMEN
BACKGROUND: American Indian and Alaska Native people (AI/AN) bear a disproportionate burden of diabetes. Growing evidence shows significant associations between several acute diabetes complications and dementia among diabetes patients. However, little is known about these relationships among AI/AN adults. Here, we aim to investigate these associations among AI/AN adults. METHODS: This cross-sectional study extracted data from the Indian Health Service's (IHS) National Data Warehouse and related administrative databases. A total of 29,337 IHS actual users with diabetes who were 45+ years old during fiscal year 2013 were included. All-cause dementia and diabetes complications were identified using ICD-9 diagnostic codes. Negative binomial regression models were used to evaluate the associations of interest. RESULTS: Nearly 3% of AI/AN diabetes patients had a dementia diagnosis. After controlling for covariates, dementia was associated with a 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50-2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11-2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53-2.41). CONCLUSIONS: AI/AN diabetes patients with dementia suffered from considerably higher rates of acute diabetes complications than their counterparts without dementia. The clinical management of patients with comorbid diabetes and dementia is particularly challenging and may require individualized treatment approaches.
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Nativos Alasqueños , Demencia , Complicaciones de la Diabetes , Indígenas Norteamericanos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nativos Alasqueños/estadística & datos numéricos , Indio Americano o Nativo de Alaska , Estudios Transversales , Demencia/epidemiología , Complicaciones de la Diabetes/epidemiología , Indígenas Norteamericanos/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Opioid-related overdose mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. Opioid-related overdose trends among American Indian and Alaska Natives require further quantification and assessment. METHODS: Observational, U.S. population-based registry data on opioid-related overdose mortality between 1999 and 2021 were extracted in 2023 using ICD-10 codes from the U.S. Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate opioid-related overdose mortality growth rates among the American Indian and Alaska Native population between 1999 and 2021. Analyses were performed in 2023. RESULTS: Two distinct time segments revealed significantly different opioid-related overdose mortality growth rates within the overall American Indian and Alaska Native population, from 0.36 per 100,000 (95% CI=0.32, 0.41) between 1999 and 2019 to 6.5 (95% CI=5.7, 7.31) between 2019 and 2021, with the most pronounced increase among those aged 24-44 years. Similar patterns were observed within the American Indian and Alaska Native population with Hispanic ethnicity, but the estimated growth rates were generally steeper across most age groups than across the overall American Indian and Alaska Native population. Patterns of opioid-related overdose mortality growth rates were similar between American Indian and Alaska Native females and males between 2019 and 2021. CONCLUSIONS: Sharp increases in opioid-related overdose mortality rates among American Indian and Alaska Native communities are evident by age and Hispanic ethnicity, highlighting the need for culturally sensitive fatal opioid-related overdose prevention, opioid use disorder treatment, and harm-reduction efforts. Future research should aim to understand the underlying factors contributing to these high mortality rates and employ interventions that leverage the strengths of American Indian and Alaska Native culture, including the strong sense of community.
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Nativos Alasqueños , Indígenas Norteamericanos , Sobredosis de Opiáceos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Nativos Alasqueños/estadística & datos numéricos , Analgésicos Opioides/envenenamiento , Analgésicos Opioides/administración & dosificación , Sobredosis de Droga/etnología , Sobredosis de Droga/mortalidad , Indígenas Norteamericanos/estadística & datos numéricos , Sobredosis de Opiáceos/mortalidad , Sobredosis de Opiáceos/etnología , Sistema de Registros , Estados Unidos/epidemiología , Indio Americano o Nativo de AlaskaAsunto(s)
Nativos Alasqueños , Melanoma , Programa de VERF , Neoplasias Cutáneas , Humanos , Melanoma/epidemiología , Melanoma/etnología , Femenino , Programa de VERF/estadística & datos numéricos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etnología , Estudios Retrospectivos , Masculino , Nativos Alasqueños/estadística & datos numéricos , Persona de Mediana Edad , Estados Unidos/epidemiología , Anciano , Factores Sexuales , Adulto , Indígenas Norteamericanos/estadística & datos numéricos , Distribución por SexoRESUMEN
INTRODUCTION: American Indian/Alaska Native (AI/AN) pregnant people face barriers to health and healthcare that put them at risk of pregnancy complications. Rates of severe maternal morbidity (SMM) among Indigenous pregnant people are estimated to be twice that of non-Hispanic White (NHW) pregnant people. METHODS: Race-corrected Oregon Hospital Discharge and Washington Comprehensive Hospital Abstract Reporting System data were combined to create a joint dataset of births between 2012 and 2016. The analytic sample was composed of 12,535 AI/AN records and 313,046 NHW records. A multilevel logistic regression was used to assess the relationship between community-level, individual and pregnancy risk factors on SMM for AI/AN pregnant people. RESULTS: At the community level, AI/AN pregnant people were more likely than NHW to live in mostly or completely rural counties with low median household income and high uninsured rates. They were more likely to use Medicaid, be in a high-risk age category, and have diabetes or obesity. During pregnancy, AI/AN pregnant people were more likely to have insufficient prenatal care (PNC), gestational diabetes, and pre-eclampsia. In the multilevel model, county accounted for 6% of model variance. Hypertension pre-eclampsia, and county rurality were significant predictors of SMM among AI/AN pregnant people. High-risk age, insufficient PNC and a low county insured rate were near-significant at p < 0.10. DISCUSSION: Community-level factors are significant contributors to SMM risk for AI/AN pregnant people in addition to hypertension and pre-eclampsia. These findings demonstrate the need for targeted support in pregnancy to AI/AN pregnant people, particularly those who live in rural and underserved communities.
What is already known on this subject? American Indian and Alaska Native pregnant people face higher rates of severe maternal morbidity and mortality, and the risk is exacerbated for rural Indigenous pregnant people.What this study adds? This publication uses a multilevel model to assess the contribution of community-level factors in severe maternal morbidity risk for American Indian and Alaska Native pregnant people. This analysis highlights the important role that rurality, prenatal care adequacy and access to insurance play in maternal morbidity risk and discusses how those risks are disproportionately felt by American Indian and Alaska Native pregnant people in the Pacific Northwest.
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Indio Americano o Nativo de Alaska , Complicaciones del Embarazo , Características de la Residencia , Determinantes Sociales de la Salud , Femenino , Humanos , Embarazo , Nativos Alasqueños/estadística & datos numéricos , Indio Americano o Nativo de Alaska/estadística & datos numéricos , Hipertensión/epidemiología , Hipertensión/etnología , Indígenas Norteamericanos/estadística & datos numéricos , Modelos Logísticos , Preeclampsia/epidemiología , Preeclampsia/etnología , Washingtón , Determinantes Sociales de la Salud/etnología , Determinantes Sociales de la Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/terapia , Población Rural/estadística & datos numéricos , Noroeste de Estados Unidos/epidemiología , Área sin Atención Médica , Pacientes no Asegurados/etnología , Pacientes no Asegurados/estadística & datos numéricosRESUMEN
OBJECTIVES: To describe skin disease prevalence, access to dermatologic care, and teledermatology interest among American Indians and Alaska Natives. METHODS: Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022. RESULTS: Most American Indian and/or Alaska Native respondents (94.5%, n=225) reported at least one skin disease. The top three active skin diseases among adolescents were acne, scarring, and eczema. The top three among adults were dry skin, hair loss, and acne. Only 20.9% (n=47) of respondents with skin disease had seen a dermatologist. Approximately one-third of respondents (34.0%, n=81) were open to engaging with teledermatology in their home; 43.3% (n=103) were open to engaging with teledermatology in their local clinic; 42.0% (n=100) were not interested in engaging teledermatology from their home or in their local clinic. CONCLUSIONS: Skin disease is prevalent and access to dermatologic care is poor among American Indian and Alaska Native people.
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Nativos Alasqueños , Dermatología , Accesibilidad a los Servicios de Salud , Indígenas Norteamericanos , Enfermedades de la Piel , Telemedicina , Humanos , Nativos Alasqueños/estadística & datos numéricos , Femenino , Adulto , Adolescente , Masculino , Enfermedades de la Piel/etnología , Enfermedades de la Piel/terapia , Adulto Joven , Indígenas Norteamericanos/estadística & datos numéricos , Persona de Mediana Edad , Telemedicina/estadística & datos numéricos , Niño , Anciano , Necesidades y Demandas de Servicios de SaludRESUMEN
Objectives. To determine the impact of disaggregated mortality and health surveillance data on the ability to identify health disparities for American Indian and Alaska Native (AI/AN) subpopulations. Methods. We conducted a systematic review of reporting categories for AI/AN decedents on official death certificates for all 50 US states. Using public data from the 2017-2018 California Health Interview Survey (CHIS), we conducted bivariate and multivariate analyses to assess disparities in health conditions and outcomes for tribally enrolled and nonâtribally enrolled AI/AN persons compared with non-Hispanic Whites. Results. There was no standard for the collection of tribal enrollment data or AI/AN race on death certificates across all 50 states. There were stark differences in the incidence and prevalence of various health risk factors and chronic diseases for the tribally enrolled AI/AN subpopulation, nonâtribally enrolled AI/AN subpopulation, and non-Hispanic White comparison group. Conclusions. The collection of tribal enrollment data in vital statistics and health surveillance systems is necessary to identify and respond to health disparities among AI/AN subpopulations. These efforts must be conducted in partnership with tribal nations and consider Indigenous data sovereignty.