Health Gaps Between American Indian/Alaska Native and White Adults in Arizona, 2017

Summary

• American Indian/Alaska Native (AI/AN) people have lower life expectancy, lower quality of life and more chronic conditions than other groups.
• A 2017 Arizona survey found that, compared with white adults, AI/AN adults had higher rates of sugary drink consumption, overweight or obesity, diabetes, high blood pressure, fair or poor health and physical inactivity — and were less likely to have a personal doctor.
• Culturally tailored public health approaches and better surveillance are needed to narrow these gaps.

Background

Arizona has the third-largest AI/AN population in the United States — about 266,000 people in 2017 — and 22 federally recognized tribal nations. Past Behavioral Risk Factor Surveillance System (BRFSS) telephone surveys reached too few AI/AN adults to draw firm conclusions, so in 2017 the federal Office of Minority Health and CDC oversampled AI/AN adults in 11 states, Arizona among them. The Arizona Department of Health Services and CDC analyzed the results.

The sample: 15,004 adults — 766 AI/AN, 12,472 white and 1,766 of other races. Response rates were 52.3% by landline and 79.6% by cell phone. Figures are age-adjusted, and only statistically significant differences are reported.

What was found

What it means

• Disadvantage: lower education and income and higher unemployment reflect the disadvantages AI/AN people face — and tackling them matters for reducing chronic disease.
• Coverage isn't access: more AI/AN adults reported coverage, but the survey counts the Indian Health Service (IHS), whose care is available only at IHS-run or IHS-funded facilities. Many may not be able to get care anywhere else, and the survey question may need revising to tell Medicare, Medicaid, IHS, Veterans Administration, private insurance and no insurance apart.
• Fewer personal doctors: IHS facilities have historically been in isolated areas on reservations, while more AI/AN people — a population growing younger and more diverse — now live in cities, which can break continuity of care. Other barriers include long waits, travel time, lack of transportation, and too few culturally and linguistically appropriate providers and preventive services.
• Deaths: in 2015, the five leading causes of death for AI/AN people in Arizona were unintentional injury, cancer, coronary heart disease, chronic liver disease and cirrhosis, and diabetes — the last two more common causes of death among AI/AN people than in the U.S. population as a whole. The higher rates of sugary drinks, inactivity, excess weight, diabetes and high blood pressure point to where population-level action is needed.

Responses

• The state's Arizona Health Improvement Plan links partners around evidence-based prevention.
• A Native American liaison at the state health department connects it with tribal communities, tribal health offices, urban Indian health programs, IHS area offices and others.
• CDC programs — "Tribal Practices for Wellness in Indian Country" and "Good Health and Wellness in Indian Country" — support culturally tailored approaches to cutting chronic disease risk.
• Tribal, state and federal agencies need to work together, and to overcome social inequities, cultural differences, low health literacy and barriers to care.

Limits: answers were self-reported; only diagnosed conditions were counted; weighting may not remove all bias; results don't show differences between tribes; place of residence (city, suburb, rural area or reservation) wasn't captured; state-level weights were used; and a snapshot survey can't show cause and effect.

Sources

Based on Monique Adakai, Michelle Sandoval-Rosario, Fang Xu, Teresa Aseret-Manygoats, Michael Allison, Kurt J. Greenlund and Kamil E. Barbour (Arizona Department of Health Services and CDC), "Health Disparities Among American Indians/Alaska Natives — Arizona, 2017," MMWR, Centers for Disease Control and Prevention; published by CDC and in the public domain; rewritten in hubnx's own words.