Abstract
BackgroundAmerican Indians and Alaska Native (AI/AN) populations experience significant health disparities compared to non-Hispanic white populations. Cardiovascular disease and related risk factors are increasingly recognized as growing indicators of global health disparities. However, comparative reports on disparities among this constellation of diseases for AI/AN populations have not been systematically reviewed.ObjectivesWe performed a literature review on the prevalence of diabetes, metabolic syndrome, dyslipidemia, obesity, hypertension, and cardiovascular disease; and associated morbidity and mortality among AI/AN.Data sourcesA total of 203 articles were reviewed, of which 31 met study criteria for inclusion. Searches were performed on PUBMED, MEDLINE, the CDC MMWR, and the Indian Health Services.Study eligibility criteriaPublished literature that were published within the last fifteen years and provided direct comparisons between AI/AN to non-AI/AN populations were included.Study appraisal and synthesis methodsWe abstracted data on study design, data source, AI/AN population, comparison group, and. outcome measures. A descriptive synthesis of primary findings is included.ResultsRates of obesity, diabetes, cardiovascular disease, and metabolic syndrome are clearly higher for AI/AN populations. Hypertension and hyperlipidemia differences are more equivocal. Our analysis also revealed that there are likely regional and gender differences in the degree of disparities observed.LimitationsStudies using BRFSS telephone surveys administered in English may underestimate disparities. Many AI/AN do not have telephones and/or speak English. Regional variability makes national surveys difficult to interpret. Finally, studies using self-reported data may not be accurate.Conclusions and implications of key findingsProfound health disparities in cardiovascular diseases and associated risk factors for AI/AN populations persist, perhaps due to low socioeconomic status and access to quality healthcare. Successful programs will address social determinants and increase healthcare access. Community-based outreach to bring health services to the most vulnerable may also be very helpful in this effort.Systematic review registration numberN/A
Highlights
IntroductionIt is recognized that American Indian and Alaskan Native (AI/ AN) populations, defined as all people who originate from and maintain tribal affiliation or community attachment with any of the original inhabitants of North, South or Central America, are affected by health disparities compared with other populations in the United States
Rates of obesity, diabetes, cardiovascular disease, and metabolic syndrome are clearly higher for AI/AN populations
Community-based outreach to bring health services to the most vulnerable may be very helpful in this effort
Summary
It is recognized that American Indian and Alaskan Native (AI/ AN) populations, defined as all people who originate from and maintain tribal affiliation or community attachment with any of the original inhabitants of North, South or Central America, are affected by health disparities compared with other populations in the United States. The AHRQ National Healthcare Disparity annual report in 2009 found that AI/ANs received worse care than Whites for about 30% of quality measures and had worse access to care than. American Indians and Alaska Native (AI/AN) populations experience significant health disparities compared to non-Hispanic white populations. Comparative reports on disparities among this constellation of diseases for AI/AN populations have not been systematically reviewed
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