Health status of urban American Indians and Alaska Natives. A population-based study

JAMA. 1994 Mar 16;271(11):845-50.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Child
  • Child, Preschool
  • Cohort Studies
  • Ethnic Groups / statistics & numerical data
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Status*
  • Health Surveys*
  • Humans
  • Indians, North American / statistics & numerical data*
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Inuits / statistics & numerical data*
  • Male
  • Middle Aged
  • Pregnancy
  • Rural Health / statistics & numerical data
  • Socioeconomic Factors
  • Urban Health / statistics & numerical data*
  • Vital Statistics*
  • Washington / epidemiology