HEALTH-STATUS OF URBAN AMERICAN-INDIANS AND ALASKA NATIVES - A POPULATION-BASED STUDY

Objective.-To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (Al/AN) population and compare it with urban whites and Africa n Americans and with Al/ ANs living on or near rural reservations. Des ign.-Descriptive analysis of routinely reported data. Setting.-One met ropolitan county and seven rural counties with reservation land in Was hington State. Subjects.-All reported births, deaths, and cases of sel ected communicable diseases occurring in the eight counties from 1981 through 1990. Main Outcome Measures.-Low birth weight, infant mortalit y, and prevalence of risk factors for poor birth outcomes; age-specifi c and cause-specific mortality; rates of reported hepatitis A and hepa titis B, tuberculosis, and sexually transmitted diseases. Results.-Urb an Al/ANs had a much higher rate of low birth weight compared with urb an whites and rural Al/ANs and had a higher rate of infant mortality t han urban whites. During the 10 years, urban Al/AN infant mortality ra tes increased from 9.6 per 1000 live births to 18.6 per 1000 live birt hs compared with no trend among the other populations. Compared with r ural Al/AN mothers, urban Al/AN mothers were 50% more likely to receiv e late or no prenatal care during pregnancy. Relative to urban whites, urban Al/AN risk factors for poor birth outcomes (delayed prenatal ca re, adolescent age, and use of tobacco and alcohol) were more common a nd closely resembled the prevalence among the African-American populat ion except for a higher rate of alcohol use among Al/ANs. Compared wit h urban whites, urban Al/AN mortality rates were higher in every age g roup except the elderly. Differences between urban whites and Al/ANs w ere largest for injury- and alcohol-related deaths. All-cause mortalit y was lower among urban Al/ANs compared with rural Al/ANs and urban Af rican Americans, although injury- and alcohol-related deaths were high er for Al/ANs. All communicable diseases studied were significantly (P <.05) more common among urban Al/ANs compared with whites. Tuberculosi s rates were highest in the urban Al/AN group, but rates of sexually t ransmitted diseases were intermediate between urban whites and African Americans. Conclusions.-In this urban area, great disparities exist b etween the health of Al/ANs and whites across almost every health dime nsion we measured. No consistent pattern was found in the comparison o f health indicators between urban and rural Al/ANs, though rural Al/AN s had lower rates of low birth weight and higher rates of timely prena tal care use. The poor health status of urban Al/AN people requires gr eater attention from federal, state, and local health authorities.