American Indian And Alaska Native Research Articles

Characterizing the etiology of recurrent tuberculosis using whole genome sequencing-Alaska, USA, 2008-2020.

Understanding the etiology of recurrent tuberculosis (rTB) is important for effective TB control. Prior to the advent of whole genome sequencing (WGS), attributing rTB to relapse or reinfection using genetic information was complicated by the limited resolution of conventional genotyping methods. We applied a systematic method of evaluating whole genome single nucleotide polymorphism (wgSNP) distances and results of phylogenetic analyses to characterize the etiology of rTB in American Indian and Alaska Native (AIAN) persons in Alaska during 2008-2020. We contextualized our findings through descriptive analyses of surveillance data and results of a literature search for investigations that characterized rTB etiology using WGS. The percentage of TB cases in AIAN persons in Alaska classified as recurrent episodes (11.8%) was three times the national percentage (3.9%). Of 38 recurrent episodes included in genetic analyses, we attributed 25 (65.8%) to reinfection based on wgSNP distances and phylogenetic analyses; this proportion was the highest among 16 published point estimates identified through the literature search. By comparison, we attributed 11 of 38 (28.9%) and 6 of 38 (15.8%) recurrent episodes to reinfection based on wgSNP distances alone and on conventional genotyping methods, respectively. WGS and attribution criteria involving genetic distances and patterns of relatedness can provide an effective means of elucidating rTB etiology. Our findings indicate that rTB occurs at high proportions among AIAN persons in Alaska and is frequently attributable to reinfection, reinforcing the importance of active surveillance and control measures to limit the spread of TB disease in Alaskan AIAN communities.

Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990–2022

Background and Objective Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. Methods We used data from the 1990–2022 National Vital Statistics System, 2015–2022 American Community Survey, and the 2018–2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. Results In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. Conclusion and Global Health Implications AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.

Changes in Racial and Ethnic Inequities in Pregnancy-Associated Death in the United States During the COVID-19 Pandemic.

Objectives. To examine changes in cause-specific pregnancy-associated deaths during the COVID-19 pandemic by race and ethnicity and assess changes in racial and ethnic inequities in pregnancy-associated deaths. Methods. We used US vital statistics mortality data from 2018 to 2021 to identify pregnancy-associated deaths among females aged 15 to 44 years. We calculated crude pregnancy-associated death rates (deaths per 100 000 live births) by year, cause, and race/ethnicity, percent change in death rate, and the inequity (difference) in rate for each racial or ethnic group compared with non-Hispanic White people. Results. The pregnancy-associated death rate for obstetric, drug-related, homicide, and other causes of death increased during 2020, and obstetric deaths continued to increase in 2021. Overall estimates mask 2021 increases in drug-related deaths among Hispanic, non-Hispanic American Indian and Alaska Native (AI/AN), and non-Hispanic Asian people; increases in homicide among most racial and ethnic groups; and increases in suicide among Hispanic, non-Hispanic AI/AN, and non-Hispanic Asian people. Conclusions. We found disproportionate increases in pregnancy-associated deaths from nonobstetric causes among minoritized racial and ethnic groups during the COVID-19 pandemic. (Am J Public Health. Published online ahead of print May 16, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307651).

Kidney Cancer Incidence Among Non-Hispanic American Indian and Alaska Native Populations in the United States, 1999-2020.

Background Non-Hispanic American Indian and Alaska Native (NH-AI/AN) people experience a disproportionate incidence of kidney cancer. Nationally aggregated data does not allow for a comprehensive description of regional disparities in kidney cancer incidence among NH-AI/AN communities. This study describes kidney cancer incidence rates and trends among NH-AI/AN compared to non-Hispanic White (NHW) populations by geographic region. Methods Using the United States Cancer Statistics American Indian and Alaska Native (AI/AN) Incidence Analytic Database, we calculated age-adjusted incidence rates (per 100,000) of kidney cancers for NH-AI/AN and NHW people for the years 2011-2020 combined using SEER*stat software. Analyses were restricted to non-Hispanic persons living in purchased/referred care delivery area (PRCDA) counties. Average annual percent changes (AAPCs) and trends (1999-2019) were estimated using Joinpoint regression analyses. Results Rates of kidney cancer incidence were higher among NH-AI/AN compared to NHW persons in the U.S. overall and in 5 of 6 regions. Kidney cancer incidence rates also varied by region, sex, age, and stage of diagnosis. Between 1999 and 2019, trends in rates of kidney cancer significantly increased among NH-AI/AN males (AAPC = 2.7%) and females (AAPC = 2.4%). The largest increases in incidence were observed for NH-AI/AN males and females under age 50 and those diagnosed with localized stage disease. Conclusions Study findings highlight growing disparities in kidney cancer incidence rates between NH-AI/AN and NHW populations. Impact: Differences in geographic region, sex, and stage highlight opportunities to decrease prevalence of kidney cancer risk factors and improve access to preventive care.

Cultural Connection and Well-being for American Indian Adolescents.

American Indian and Alaska Native (AI/AN) adolescents face health disparities resulting from historical traumas. There is a paucity of research focusing on mental health in AI/AN adolescents or the relationship between cultural connection and health. This project assesses the relationship between cultural identity and markers of mental health and well-being for AI/AN adolescents. Adolescents 12 to 18 years old from the Lumbee Tribe of North Carolina participated in this mixed-methods study. Phase 1, discussed in this manuscript, involved surveys using validated instruments to assess cultural connection and markers of mental health and well-being. Characteristics of the 122 AI/AN youth who completed the survey included: mean age 14.9 years (SD = 2.0); 61% (n = 75) assigned female at birth; 56% (n = 70) identified as female; and 4.1% (n = 5) identified as non-binary. Mean tribal affiliation (TA) and ethnic identity (EI) scores suggest strong cultural connection (TA: M = 3.1/5, SD = 0.6; EI: M = 3.4/5, SD = 0.9). Sleep quality (M = 2.63/5) and positive stress management (M = 2.06/5) were low. Bivariate and logistic regression demonstrated moderate positive correlations between EI and friendship, EI and emotional support, TA and friendship, and TA and emotional support. AI/AN adolescents in this sample have a moderate-strong connection with Native culture, marked by ethnic identity and tribal affiliation, and positive markers of mental health and well-being. Data from this study may be used for policy formulation to promote increased funding and programming addressing mental health for AI/AN youth.

Limited Access to Obstetric Services for the American Indian and Alaska Native Population [ID 2683412

INTRODUCTION: American Indian and Alaska Native (AI/AN) people face one of the highest rates of maternal mortality in the United States. Access to maternity care is correlated with health outcomes; however, research on availability of maternity care in areas largely composed of AI/AN populations is limited. METHODS: We identified the 69 counties and county-equivalents in the United States with greater than or equal to 25% of the population self-identifying as AI/AN. Counties and county-equivalents were further classified as rural (micropolitan and non-core) or urban (metropolitan). We then determined the availability of hospitals with obstetric care, obstetric providers (obstetricians and certified nurse-midwives), and the number of live births in counties and county-equivalents. Maternity care deserts were defined as counties and county-equivalents having no hospitals providing obstetric care nor obstetric providers. Limited access to maternity care services was defined as counties and county-equivalents having one or less hospital offering obstetric services and fewer than 60 obstetric providers per 10,000 births. RESULTS: These counties and county-equivalents spanned 13 states, and 65 (94.2%) were classified as rural. 39 counties and county-equivalents (56.5%) were classified as maternity care deserts, and 10 were classified as having limited access to maternity care (14.5%). CONCLUSION: The findings of this study suggest that access to maternity care is limited for AI/AN populations. Increasing access to care in counties and county-equivalents largely composed of AI/AN populations is a potential avenue to improve maternal health outcomes.

Recommendations for Modernizing a Culturally Grounded Substance Use Prevention Program for American Indian and Alaska Native Youth.

American Indian and Alaska Native (AI/AN) youth use alcohol and drugs at a higher rate with earlier onset than the overall youth population in the United States. Youth interventions are needed to support the prevention and reduction of substance misuse-related issues. Connecting AI/AN children to their heritage through culturally grounded prevention programs has been shown to be more effective than programs designed for the general population. The objective of this formative evaluation was to provide community-informed updates for an existing culturally grounded substance use prevention program, The Beauty Way. This study was conducted in partnership with an AI/AN-serving community organization using key informant interviews and talking circles with community members and parents. Participants revealed the challenges and obstacles AI/AN youth face, the impact of cultural values, and activities which engage youth to prevent problematic substance use. Recommendations include the importance of 1) incorporating current challenges to behavioral health such as social media and vaping, 2) including cultural values and activities including land-based learning, and 3) creating a robust facilitator guide and hiring culturally sensitive program staff. These results generated recommendations to strengthen the cultural focus and application of The Beauty Way for AI/AN youth.

Adapting a Financial Incentives Intervention for Smoking Cessation with Alaska Native Families: Phase 1 Qualitative Research to Inform the Aniqsaaq (To Breathe) Study.

Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. We conducted individual, semi-structured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022-March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and non-cash incentives for family members to choose (e.g., fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (e.g., nicotine replacement, counseling). Adaptations, grounded in ANAI cultural strengths were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among Alaska Native or American Indian (ANAI) peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention.

Neurological Care within the Indian Health Service.

American Indians and Alaska Natives (AI/AN) are the Indigenous peoples of the United States. According to the U.S. Census Bureau, approximately 9.7 million people self-identified as AI/AN (alone or in combination with other races), representing 2.9% of the total U.S. population. These people represent diverse groups of discrete Tribes, each with their language, culture, and geographic home. As part of the conquest and settlement of North America, some Indigenous peoples signed treaties with the U.S. government, surrendering their lands in return for various government commitments, including health care. The Indian Health Service (IHS) was born out of these agreements. The IHS is an agency in the U.S. Department of Health and Human Services under the U.S. Public Health Service. The IHS provides a comprehensive health service delivery system for approximately 2.7 million AI/AN who belong to 574 federally recognized Tribes/nations in 37 states. The aim of this paper is to make recommendations regarding the initiation of sustainable neurology care in marginalized or underserved populations by reviewing 40 years of neurology care provision within the IHS. We will discuss (1) the IHS, (2) neurological care provided within the IHS, including midlevel provider extension of neurology care and traditional medical care, and (3) select neurological diagnoses within AI/AN populations. Marginalized populations, including those in the United States that are rural, remote, or low socioeconomic status, lack access to specialty neurology care. This includes many AI/AN. The IHS has developed novel solutions to promote specialty care, including neurology. Notably, initial IHS investments in full-time neurology providers have led to more robust neurology care, often receiving attention from university programs. This suggests that an initial investment in stable on-site full-time neurology services provides a path to potential sustainable care for marginalized populations.

American Indian and Alaska Native violence prevention efforts: a systematic review, 1980 to 2018

BackgroundViolence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations.MethodsA review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population.ResultsA total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results.ConclusionsThis review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations.

Urgent versus elective surgical disparities among American Indian and Alaska Native patients.

American Indian and Alaska Native (AIAN) health issues are understudied despite documentation of lower-than-average life expectancy. Urgent surgery is associated with higher rates of postsurgical complications and postoperative death. We assess whether American Indian and Alaska Native (AIAN) patients in Washington State are at greater risk of requiring urgent rather than elective surgery compared with non-Hispanic Whites (NHW). We accessed data for the period 2009-2014 from the Washington State Comprehensive Hospital Abstract Reporting System (CHARS) database, which captures all statewide hospital admissions, to examine three common surgeries that are performed both urgently and electively: hip replacements, aortic valve replacements, and spinal fusions. We extracted patient race, age, insurance status, comorbidity, admission type, and procedures performed. We then constructed multivariable logistic regression models to identify factors associated with use of urgent surgical care. AIAN patients had lower mean age at surgery for all three surgeries compared with NHW patients. AIAN patients were at higher risk for urgent surgery for hip replacements (OR=1.49, 95% CI 1.19-1.88), spinal fusions (OR=1.39, 95% CI 1.04-1.87), and aortic valve replacements (OR=2.06, 95% CI 1.12-3.80). AIAN patients were more likely to undergo urgent hip replacement, spinal fusion, and aortic valve replacement than NHW patients. AIAN patients underwent urgent surgery at younger ages. Medicaid insurance conferred higher risks for urgent surgery across all surgeries studied. Further research is warranted to more clearly identify the factors contributing to disparities among AIAN patients undergoing urgent surgery.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents.

This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association. The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire. Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss. Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract HUP14: Racial And Ethnic Disparities In Neighborhood Socioeconomic Status Associated With Cardiovascular Disease And Stroke: The Women’s Health Initiative

Introduction: The role of socioeconomic status (SES) across cardiovascular diseases (CVD) is well researched at the individual-level but fails to explain the greater CVD rates among Black and American Indian and Alaska Native (AIAN) groups at every level of SES. This research evaluated whether lower Neighborhood SES (NSES), a structural determinant of health, was associated with racial and ethnic disparities in CVD or stroke among aging women. Methods: The data came from the Women’s Health Initiative (WHI) cohort, consisting of 161,808 postmenopausal women with 30 years of data on stroke and CVD incidence. The NSES data were obtained from the US Census based on participant’s census tract of residence. We evaluated racial and ethnic disparities in the exposure and outcome prevalence using ANOVA. Associations between NSES and time to stroke and CVD were evaluated using multivariate adjusted Cox Regression models, and models were stratified by race and ethnicity to evaluate disparities. Results: NSES differed by race and ethnicity. Black, AIAN, and Latina groups were significantly (P&lt;0.01) more likely to live in neighborhoods with NSES Z-scores below the population mean (Z-score=0) compared with White and Asian groups. The mean NSES Z-score among Black participants was -5.21 standard deviations below the population mean. Thirty-year CVD and stroke incidence followed the same trajectory of racial disparities. Preliminary analysis suggests results from Cox regression models will identify lower NSES to be longitudinally associated with greater stroke and CVD incidence overall, and greater effect sizes among groups experiencing structural racism. Conclusion: This research evaluates racial disparities in NSES as a structural determinant of stroke and CVD. These findings provide evidence emphasizing the need for neighborhood-level interventions to improve CVD disparities that coalesce in marginalized communities.

Individual and cumulative firearm violence exposure: Implications for sleep among Black and American Indian/Alaska Native adults

PurposeWe investigated the relationship between various forms of firearm violence exposure and sleep problems among nationally representative samples of Black (N = 3015) and American Indian and Alaska Native (AI/AN) (N = 527) adults, focusing on difficulties falling asleep, staying asleep, and waking too early. Survey data were collected in April and May 2023. MethodsWe employed negative binomial regression models to analyze the associations between the different types of firearm violence exposure and sleep problems. We further examined associations between cumulative firearm violence exposure and sleep outcomes. ResultsA substantial proportion of Black (59%) and AI/AN (56%) adults reported experiencing some form of firearm violence exposure. Being threatened with a firearm emerged as a consistent factor associated with sleep problems for both racial groups. Witnessing or hearing about shootings was linked to sleep problems in the Black sample, while cumulative firearm violence exposure was associated with all sleep problems in both groups. ConclusionsIndividual and cumulative firearm violence exposure is associated with increased sleep problems among Black and AI/AN adults.

MAKING OLDER ADULT FALL PREVENTION A ROUTINE PART OF HEALTHCARE IN TRIBAL CLINICAL SETTINGS

Abstract Over one-third of American Indian and Alaska Native (AI/AN) elders (age 65+) report falling annually. This percentage is higher compared to other race/ethnic groups except for White non-Hispanic older adults. CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides guidance for making elder fall prevention a routine part of clinical care. The presentation will describe a survey of healthcare providers serving AI/AN populations to gauge their readiness to adopt STEADI. Additionally, it will focus on a culturally informed approach to implementing STEADI within tribal settings. The National Network of Public Health Institutes and Seven Directions, A Center for Indigenous Public Health, surveyed a convenient sample of healthcare providers in clinics serving AI/AN patients to assess providers’ knowledge and acceptability of fall prevention best practices, efforts to prevent falls, and receptiveness to receiving fall prevention training and support. The final sample included 94 healthcare providers from 27 clinics. Less than half of those surveyed reported screening elders for fall risk. Only 22% were familiar with STEADI. Most (84%) providers were willing to take part in fall prevention with additional training. Based on these findings CDC is funding two tribes to use an indigenous evaluation approach to improve their tribal health center’s elder fall prevention capacity through evidence-based clinical and clinical-community linked strategies. Results from these activities will be used to outline a best practices guide focused on coordinated care for fall prevention and tailored to the varied environments, governments, cultures, and capacity for public health action in tribal health centers.

Acceptability and feasibility of an intervention for Alaska Native and American Indian couples.

This acceptability and feasibility study assessed a previously tested movie discussion intervention culturally adapted for a tribal health setting. Despite family and relationships being important in Alaska Native and American Indian (ANAI) cultures, social health interventions supporting committed ANAI couples have not been investigated. Couples watching and discussing movies can promote and sustain relationship health as effectively as intensive skill-building classes. This study culturally adapted a movie discussion intervention. Multiple stakeholders guided adaptations, including changes to intervention duration, recommended movies, discussion guide, and study measures. Eligible participants were cohabitating adults in a committed relationship, with at least one person in the couple being ANAI. Participants watched and discussed movies over 4 weeks at home or in person. Study measures assessed demographics, relationship characteristics, and intervention acceptability and feasibility. Twenty-three couples participated: 87% chose at-home participation, 70% completed the intervention. Almost 90% of couples felt comfortable discussing the movies, felt the discussion guide improved communication, and would recommend the intervention to other couples, but 26% were mildly stressed by the discussions. This intervention was a feasible and acceptable way to help ANAI couples maintain positive relationship features. This intervention could support ANAI couples in regions with limited access to behavioral health services.

RACIAL AND ETHNIC DISPARITIES IN NEIGHBORHOOD SOCIOECONOMIC CHARACTERISTICS ASSOCIATIONS WITH VISCERAL FAT

Abstract Visceral adipose tissue (VAT) has a more significant role in the pathophysiology of cardiometabolic diseases than subcutaneous adipose tissue (SAT). Our previous findings suggest VAT represents an important pathway through which racial disparities in the social environment are biologically embodied. To understand the role of structural racism in this pathway, this paper investigated racial disparities in neighborhood socioeconomic status (NSES) and VAT. We hypothesized that NSES is inversely associated with VAT and VAT/SAT ratio over 6 years and associations differ by race and ethnicity. Abdominal VAT and SAT area (cm2) were measured at years 0, 3, and 6 using dual-energy X-ray absorptiometry in a subsample (n=11,020) of the Women’s Health Initiative (age 50-79). The NSES Z-scores were obtained from the US Census and American Community Survey based on participant’s census tract residence. We evaluate racial and ethnic disparities in the exposure and outcome using ANOVA, and associations between NSES with VAT using mixed effects models. We found that NSES and VAT area differed by race and ethnicity. American Indian and Alaska Native (AIAN), Black, and Latina groups were significantly (P&amp;lt; 0.01) more likely to live in neighborhoods with NSES Z-scores below the population mean (Z-score=0) compared with White and Asian races. AIAN, Latina, and Black women had the highest VAT (220 cm2, 185 cm2, 177 cm2, respectively). Findings support the hypothesis that associations between NSES and VAT differ by race and ethnicity. Results from mixed effects models are expected to provide longitudinal evidence that structural determinants are associated with VAT.

Trends in Premature Mortality from Acute Myocardial Infarction in American Indians/Alaska Natives in the United States from 1999 to 2020

Cardiovascular disease is the leading cause of mortality in American Indian and Alaska Native (AI/AN) groups. They are disproportionately found to have a higher rates of premature myocardial infarction (MI). The CDC WONDER (Centers for Disease Control and Prevention) was queried to identify premature MI deaths (female <65 years and male <55 years) occurring within the United States between 1999-2020. We investigated proportionate mortality trends related to premature MI among AI/ANs stratified by sex. Deaths attributed to AMI were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) codes I21- I22. We compared the proportional mortality rate due to premature MI to that of non-AI/AN racial group, which comprised of all other races (Blacks, Whites, and Asian/Pacific Islander populations). In AI/ANs, we analyzed a total of 14,055 acute myocardial infarction (AMI) deaths of which 3,211 were premature MI deaths corresponding to a proportionate mortality rate of 22.8% (male 20.8%, female 26.2%). Non- AI/AN population had a lower proportionate mortality of 14.8% (male 13.7%, female 16%); p<0.01). On trend analysis, there was no significant improvement over time in the proportionate mortality of AI/ANs (19.8% in 1999 to 21.7% in 2020, p=0.09). Upon comparison of sex, proportionate mortality of premature MI in females showed a non-statistically significant increase from 21.6% in 1999 to 27.3% in 2020 [average annual percent change (AAPC) of 0.7; p=0.06)]. However, males had a statistically significant decrease in proportionate mortality of premature MI from 18.5% in 1999 to 18.2% in 2020 [AAPC of -0.8; p=0.01)]. AI/ANs have an alarmingly higher rate of proportionate mortality of premature MI compared to other races, with no improvement in the proportionate mortality rates over 20 years, despite an overall downtrend in AMI mortality. Further research to address the reasons for the lack of improvement in premature MI is needed to improve outcomes in this patient population.

Retention of American Indian and Alaska Native participants in the National Alzheimer's Coordinating Center Uniform Data Set.

The number of American Indian and Alaska Native (AI/AN) elders is expected to double by 2060. Thus it is imperative to retain AI/AN participants in longitudinal research studies to identify novel risk factors and potential targets for intervention for Alzheimer's disease and related dementias in these communities. The National Alzheimer's Coordinating Center houses uniformly collected longitudinal data from the network of National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADRCs). We used logistic regression to quantify participant retention at 43 ADRCs, comparing self-identified AI/AN participants to non-Hispanic White (NHW) participants, adjusting for potential confounding factors including baseline diagnosis, age, sex, education, and smoking. The odds of AI/AN participant retention at the first follow-up visit were significantly lower than those for NHW participants (adjusted odds ratio [aOR]: 0.599; 95%: 0.46-0.78; p<0.001). These results suggest the need for improved strategies to retain AI/AN participants, perhaps including improved researcher-community relationships and community engagement and education. American Indian and Alaska Native (AI/AN) research participants were retained to the first follow-up appointment at lower rates than non-Hispanic White (NHW) participants. AI/AN participants are retained at lower rates than NHW participants for long-term follow-up. The majority of AI/AN participants were not retained to the second follow-up visit.

Incidence trends in prostate cancer among men in the United States from 2000 to 2020 by race and ethnicity, age and tumor stage.

To explore whether prostate cancer incidence trends from 2000 to 2020 in the United States differed by race and ethnicity, age and tumor stage; to explore racial differences in prostate cancer incidence change due to the impact of COVID-19 pandemic lockdown in 2020; and to determine if there is any high-risk population that can be targeted for prevention. We identified 1,098,349 men who were diagnosed with incident prostate cancer at age ≥20 in 2000-2020 in 17 registries of the Surveillance, Epidemiology, and End Results (SEER) program in the United States; of whom, 778,437 were non-Hispanic whites, 155,111 non-Hispanic blacks, 4,200 American Indians and Alaska Natives (AIAN), 55,267 non-Hispanic Asians/Pacific Islanders, and 105,334 Hispanics. Age-adjusted incidence rate of prostate cancer was the highest in blacks (302.6 cases per 100,000 men), followed by whites (186.6), Hispanics (153.2), AIAN (108.5), and Asians (104.9). Age-adjusted prostate cancer incidence rates dramatically decreased from 2000 to 2013 for all ethnic men. However, age-adjusted prostate cancer incidence rates increased from 2014 to 2020, in which the increasing incidence trend looked sharper in blacks and whites, flatter in Asians, and leveled in AIAN and Hispanics. Among men with local or regional stages across all years, prostate cancer incidence rate was significantly higher in blacks, but significantly lower in Hispanics, AIAN, and Asians as compared to whites. Among men in 2007-2013, the risk of distant stage prostate cancer was statistically significantly elevated in blacks (rate-ratio: 2.22, 95% CI: 2.06-2.38) and Hispanics (1.16, 1.06-1.25), not significantly different in AIAN (1.30, 0.92-1.76), but still significantly lower in Asians (0.73, 0.66-0.82) as compared to whites. There was a drop of prostate cancer incidence from 2019 to 2020 likely due to the impact of COVID-19 pandemic lockdown on the access to medical care in 2020. Overall prostate cancer incidence rate decreased by 40.4 cases per 100,000 population from 277.4 in 2019 to 237.0 in 2020 for blacks, 20.9 from 164.2 to 143.3 for whites, 16.8 from 124.8 to 108.0 for Hispanics, 14.9 from 101.7 to 86.8 for AIAN, and 12.6 from 88.4 to 75.8 for Asians. The decreasing trend of prostate cancer incidence from 2000 to 2013 was statistically significant for all ethnic men. There was an increasing prostate cancer incidence from 2014 to 2020. Age-adjusted incidence rate of prostate cancer was the highest in blacks, followed by whites, Hispanics, AIAN, and Asians, regardless of age groups, tumor stages, and time periods. There will also be a need to monitor and investigate the prostate cancer incidence trend during and after COVID-19 pandemic season.