“American Indian” as a Racial Category in Public Health: Implications for Communities and Practice

Gartner, Danielle R.; Wilbur, Rachel E.; McCoy, Meredith L.

doi:10.2105/ajph.2021.306465

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…With respect to place, we found complex nation-wide patterns of COVID-19 deaths: several Native American nations in Arizona, New Mexico, Wyoming, and Montana have mortality risk in excess of what can be attributed to race and class, highlighting the local challenges of healthcare delivery in those areas. 50 In contrast, large portions of the West, and especially California, Oregon, Washington, Utah, and Nevada, were relatively protected from COVID-19 mortality, after adjusting for race and class.…”

Section: Discussionmentioning

confidence: 98%

Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999–2021

et al. 2023

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Background Race and ethnicity, socioeconomic class, and geographic location are well-known social determinants of health in the US. Studies of population mortality often consider two, but not all three of these risk factors. Objectives To disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US. Design We conducted a retrospective analysis of death certificate data. Bayesian regression models, adjusted for age and race/ethnicity from the American Community Survey and the county Area Deprivation Index, were used for inference. Main Measures County-level mortality for 11 leading causes of death (1999–2019) and COVID-19 (2020–2021). Key Results County “whiteness” and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5–8% increase in death from three causes and 4–15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Patterns of residual risk, measured by spatial county effects, varied by cause of death; for example: cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths. Conclusions There are important independent contributions from race, class, and geography to risk of death in the US. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08062-1.

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Section: Discussionmentioning

confidence: 98%

Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999–2021

et al. 2023

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“…Third, there may be systematic differences in the under‐reporting of comorbidities on birth certificates, particularly by race and ethnicity 72 . Furthermore, American Indian and Alaska Native individuals are undercounted due to racial and ethnic “misclassification.” 52,73–75 An ideal sensitivity analysis would identify tribally‐affiliated or enrolled American Indian and Alaska Native people, 51 or ensure that all birth certificates used self‐reported race and ethnicity. Yet, these data do not exist at the national level.…”

Section: Discussionmentioning

confidence: 99%

“…Because American Indian and Alaska Native status is both a political and racial identity, 51 we redefined the American Indian and Alaska Native maternal race and ethnicity category to include anyone with American Indian and Alaska Native racial identity, including multi‐racial and/or Hispanic American Indian and Alaska Native individuals 52…”

Section: Methodsmentioning

confidence: 99%

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Inequalities in cesarean births between American Indian & Alaska Native people and White people

Gartner

Debbink

Brooks

et al. 2023

Health Services Research

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Objective: To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. Data Sources and Study Setting: We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. Study Design: We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality. Data Collection/Extraction Methods: Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate.Principal Findings: After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0-34.8), 3.2 percentage points (95% CI: 1.8-4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). Conclusions:The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.

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“…Additionally, with respect to place, we found complex nation-wide patterns of COVID-19 deaths. For example, several Native American nations in Arizona, New Mexico, Wyoming, and Montana have mortality risk in excess of what can be attributed to race and class, highlighting the local challenges of healthcare delivery in those locales 47 . In stark contrast, large portions of the US West, and especially California, Oregon, Washington, Utah, and Nevada, were relatively protected from COVID-19 mortality, after adjusting for race and class.…”

Section: Discussionmentioning

confidence: 99%

Race, class, and place modify mortality rates for the top 12 causes of death in the United States, 1999-2021

Formanack

Doshi

Valdez

et al. 2022

Preprint

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ObjectivesTo disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US.MethodsWe studied mortality in US counties for 11 causes of death (1999-2019) and COVID-19 (2020-2021). We adjusted for race and age using the American Community Survey and socioeconomic status using the Area Deprivation Index. Bayesian regressions with spatial county effects were estimated for inference.ResultsCounty whiteness and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5-8% increase in death from three causes and 4-15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Geospatial patterns of residual risk varied by cause of death. For example, cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths.ConclusionsThere are important independent contributions from race, class, and geography to risk of death in the US.

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“American Indian” as a Racial Category in Public Health: Implications for Communities and Practice

Cited by 16 publications

References 19 publications

Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999–2021

Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999–2021

Inequalities in cesarean births between American Indian & Alaska Native people and White people

Race, class, and place modify mortality rates for the top 12 causes of death in the United States, 1999-2021

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