Identifying Disparities in Health Outcomes and Mortality for American Indian and Alaska Native Populations Using Tribally Disaggregated Vital Statistics and Health Survey Data

Am J Public Health. 2021 Jul;111(S2):S126-S132. doi: 10.2105/AJPH.2021.306427.

Abstract

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 non‒tribally 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, non‒tribally 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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alaska Natives* / statistics & numerical data
  • American Indian or Alaska Native* / statistics & numerical data
  • Cause of Death*
  • Female
  • Forecasting
  • Health Surveys*
  • Healthcare Disparities / statistics & numerical data
  • Healthcare Disparities / trends
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mortality* / trends
  • Multivariate Analysis
  • Outcome Assessment, Health Care* / statistics & numerical data
  • Population Surveillance
  • Prevalence
  • United States
  • Vital Statistics