Health status of urban American Indians and Alaska Natives. A population-based study
Authors: Grossman DC., Krieger JW. , Sugarman JR., Forquera, Ralph
Publication Year: 1994
Last Updated: 2010-01-21 08:14:08
Journal: JAMA
Keywords: Adolescence; Adult; Aged; Cause of Death; Child; Child, Preschool; Ethnic Groups; Health Status; Health Surveys; Infant; Middle Age; Rural Health/Statistics & Numerical Data; Socioeconomic Factors; Urban Health/Statistics & Numerical Data; Vital Statistics
Short Abstract: 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 AI/ANs living on or near rural reservations.
Abstract: 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 AI/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.
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Code: 3096
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