COVID-19 Mortality Among American Indian and Alaska Native Persons — 14 States, January–June 2020

Abstract

American Indian/Alaska Native (AI/AN) persons experienced disproportionate mortality during the 2009 influenza A(H1N1) pandemic (1,2). Concerns of a similar trend during the coronavirus disease 2019 (COVID-19) pandemic led to the formation of a workgroup* to assess the prevalence of COVID-19 deaths in the AI/AN population. As of December 2, 2020, CDC has reported 2,689 COVID-19associated deaths among non-Hispanic AI/AN persons in the United States. † A recent analysis found that the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN persons was 3.5 times that among White persons (3). Among 14 participating states, the age-adjusted AI/AN COVID-19 mortality rate (55.8 deaths per 100,000; 95% confidence interval [CI] = 52.5-59.3) was 1.8 (95% CI = 1.7-2.0) times that among White persons (30.3 deaths per 100,000; 95% CI = 29.9-30.7). Although COVID-19 mortality rates increased with age among both AI/AN and White persons, the disparity was largest among those aged 20-49 years. Among persons aged 20-29 years, 30-39 years, and 40-49 years, the COVID-19 mortality rates among AI/AN were 10.5, 11.6, and 8.2 times, respectively, those among White persons. Evidence that AI/AN communities might be at increased risk for COVID-19 illness and death demonstrates the importance of documenting and understanding the reasons for these disparities while developing collaborative approaches with federal, state, municipal, and tribal agencies to minimize the impact of COVID-19 on AI/AN communities. Together, public health partners can plan for medical countermeasures and prevention activities for AI/AN communities.During July 22-September 3, 2020, data were collected on confirmed COVID-19-associated deaths that occurred during January 1-June 30, 2020, from 14 participating states. § These states represent approximately 46.5% of the AI/AN population * Representatives from 14 state health departments,

COVID-19 Incidence and Mortality Among American Indian/Alaska Native and White Persons — Montana, March 13–November 30, 2020

“…An assessment of the impact of COVID-19 among AI/AN persons from 23 states made early during the pandemic (January–July 2020) found that the cumulative incidence rate ratio between AI/AN and White persons was 3.5 ( 2 ), similar to the current study’s finding. In addition, a study comparing age-adjusted COVID-19 mortality rates among AI/AN and White persons in 14 states during January–June 2020 reported a mortality rate ratio of 1.8 for AI/AN persons compared with that for White persons ( 3 ), which was lower than that identified in a supplementary analysis conducted by MDPHHS. ¶¶…”

“…Geographic differences in infectious disease mortality rates have been observed among American Indian or Alaska Native (AI/AN) persons in the United States ( 1 ), and aggregate analyses of data from selected U.S. states indicate that COVID-19 incidence and mortality are higher among AI/AN persons than they are among White persons ( 2 , 3 ). State-level data could be used to identify disparities and guide local efforts to reduce COVID-19–associated incidence and mortality; however, such data are limited.…”

Our Collective Needs and Strengths: Urban AI/ANs and the COVID-19 Pandemic

“…CDC data show that AI/ANs are 3.5 times more likely to contract COVID-19 and to be hospitalized than non-Hispanic Whites in the United States ( Center for Disease Control and Prevention, 2020b ; Center for Disease Control and Prevention, 2020c ; Center for Disease Control and Prevention, 2020d ; Hatcher et al, 2020 ). Additionally, the age adjusted mortality rate for COVID-19 was 1.8 times higher in AI/ANs than in non-Hispanic Whites ( Arrazola et al, 2020 ). As with all races, COVID-19 mortality rates appear to be increasing with age for AI/AN peoples, but the largest mortality disparity between AI/ANs and non-Hispanic whites is in the age group of 20–49 years ( Arrazola et al, 2020 ).…”

“…Additionally, the age adjusted mortality rate for COVID-19 was 1.8 times higher in AI/ANs than in non-Hispanic Whites ( Arrazola et al, 2020 ). As with all races, COVID-19 mortality rates appear to be increasing with age for AI/AN peoples, but the largest mortality disparity between AI/ANs and non-Hispanic whites is in the age group of 20–49 years ( Arrazola et al, 2020 ). COVID-19 mortality rates by both sexes for AI/ANs are 1.8 times that of non-Hispanic Whites of the respective sex ( Arrazola et al, 2020 ).…”

“…As with all races, COVID-19 mortality rates appear to be increasing with age for AI/AN peoples, but the largest mortality disparity between AI/ANs and non-Hispanic whites is in the age group of 20–49 years ( Arrazola et al, 2020 ). COVID-19 mortality rates by both sexes for AI/ANs are 1.8 times that of non-Hispanic Whites of the respective sex ( Arrazola et al, 2020 ). Additional considerations for AI/ANs that may increase risk for COVID-19 include; historical medical mistreatment that may make AI/AN individuals reluctant to seek care, high levels of perceived discrimination in healthcare, and that nationally nearly one-third of AI/ANs under 65 years of age do not have health insurance ( Burgess et al, 2008 ; Findling et al, 2019 ; Center for Disease Control and Prevention, 2020e ).…”