HEALTH-STATUS OF URBAN AMERICAN-INDIANS AND ALASKA NATIVES - A POPULATION-BASED STUDY

Objective.-To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (Al/AN) population and compare it with urban whites and African Americans and with Al/ 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 Al/ANs had a much higher rate of low birth weight compared with urban whites and rural Al/ANs and had a higher rate of infant mortality than urban whites. During the 10 years, urban Al/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 Al/AN mothers, urban Al/AN mothers were 50% more likely to receive late or no prenatal care during pregnancy. Relative to urban whites, urban Al/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 Al/ANs. Compared with urban whites, urban Al/AN mortality rates were higher in every age group except the elderly. Differences between urban whites and Al/ANs were largest for injury- and alcohol-related deaths. All-cause mortality was lower among urban Al/ANs compared with rural Al/ANs and urban African Americans, although injury- and alcohol-related deaths were higher for Al/ANs. All communicable diseases studied were significantly (P<.05) more common among urban Al/ANs compared with whites. Tuberculosis rates were highest in the urban Al/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 Al/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 Al/ANs, though rural Al/ANs had lower rates of low birth weight and higher rates of timely prenatal care use. The poor health status of urban Al/AN people requires greater attention from federal, state, and local health authorities.