Comorbidities, area social deprivation, and access to treatment were all important contributors to the mortality disparity between American Indians and Alaska Natives compared to white inpatients with COVID-19, according to new research analysis.
The results, published in Scientific Reports and based on data gathered from the COVID EHR Cohort at the University of Wisconsin (CEC-UW), is the first to explain why American Indians and Alaska Natives were more likely to die while in the hospital. While those three factors were important contributors, they didn’t completely explain the disparity.
One variable that didn’t factor into the disparity? Smoking.
“I was surprised that we saw little difference in smoking prevalence between racial groups in this study,” said Dr. Wendy Slutske, UW-CTRI researcher and lead author of the paper, when past survey research has reflected American Indians reporting that they smoke commercial tobacco at higher rates.
Co-author Karen Conner, who spent the first eight years of her career working for the Alaska Native Tribal Health System, acknowledged that some of these results may reflect legacies of failing to address historical and ongoing inequities.
“It was important to me that we explored whether there were any disparities in our data among American Indian and Alaska Native people, especially because early on in the pandemic, this population was dying at much higher rates,” Conner said. “I was thrilled when Wendy expressed interest in leading this paper.”
Conner added that, historically, indigenous people have experienced a more significant burden of noncommunicable and infectious diseases. The COVID-19 pandemic was no different.
Other factors could include living conditions during the COVID-19 pandemic, such as multigenerational and crowded housing, or being a frontline worker, the researchers wrote.
This study compared the outcomes of 546 American Indians and Alaska Natives to 78,128 white individuals from 21 US health systems who were hospitalized with COVID-19 from February 1, 2020 to January 31, 2022.
In matched samples, American Indians and Alaska Natives who were hospitalized with COVID-19 were significantly more likely than white patients to be diagnosed with the comorbid conditions of Type 2 diabetes, chronic renal failure, liver disease, and alcohol use disorder.
Although the American Indians and Alaska Natives in this study were predominantly from cities (86.4%), they were more likely to live much farther away from treatment than white patients. American Indians and Alaska Natives were more than twice as likely to reside in disadvantaged neighborhoods.
Liver disease accounted for the largest portion of the comorbidity-related mortality disparity between American Indians and Alaska Natives versus white patients.
The authors wrote that higher rates of intubation, ICU admission, and days hospitalized suggest that American Indians and Alaska Natives may have presented to inpatient care later in the COVID-19 disease course compared to white inpatients.
Slutske WS, Conner KL, Kirsch JA, Smith SS, Piasecki TM, Johnson AL, McCarthy DE, Henderson PN, Fiore MC. (2023) Explaining COVID-19 Related Mortality Disparities in American Indians and Alaska Natives. Scientific Reports. 13:20974. Online November 28, 2023.