Washington, DC (December 18, 2020) – Mortality rates related to COVID-19 related infections for American Indian and Alaska Native (AI/AN) people are higher in almost every age group, with AI/AN people 1.8 to 11.6 more times likely to die than their white counterparts within respective age groups, according to a report released by the U.S. Centers for Disease Control and Prevention last week.
The disparity in death rates is most significant among AI/AN people aged 30-39, who are nearly 12 times more likely to die than whites in the present study.
The oldest-old AI/AN elders (80 or more years of age) and their white counterparts infected with COVID-19 have the highest age-adjusted death rate (488.3 and 520.1 per 100,000).
Though the difference between AI/AN and white mortality rates decline as age increases, people of both races are more likely to die as they get older. The mortality rate among AI/AN people aged 30-39 is 19.8 per 100,000; this rate increases 11-fold for AI/AN people in the 70-79 age group.
The Bottom Line: Younger AI/AN people infected with COVID-19 are far more likely to die than their white counterparts. Overall, older AI/AN people infected with COVID-19 people are far more likely to die.
A previous CDC study found that AI/AN people were 3.5 times more likely to test positive for COVID-19 than non-Hispanic whites. Additional ongoing COVID-19 CDC surveillance data indicates that as of November 30, 2020, AI/AN people were four times more likely to be hospitalized and 2.6 times more likely to die. Only 52% of surveillance case reports include race and ethnicity data.
In-depth studies, coupled with surveillance data, provide conclusive evidence that AI/AN people, along with other people of color, continue to be disproportionately affected by COVID-19. While we applaud the continued effort on the part of the CDC, research teams who work tirelessly on these and future studies, and others in their ongoing efforts to systematically gather accurate and complete data to drive policy and decision-making, far more remains to be done.
Unfortunately, we still have little conclusive data or evidence to explain why these disparities exist. Scarcity of data on the relationship of underlying health conditions, socioeconomic factors, health access, or transportation barriers coupled with significant limitations in existing data, including racial misclassification concerns for Native people, means we only have one piece of the puzzle.
It is no coincidence that the current study opens by acknowledging the work results from disproportionate mortality among AI/AN population during the 2009 H1N1 pandemic. More than a decade later, researchers continue to point to health, access, and social determinants of health as possible causative or related factors. Past historical abuses, government distrust, ongoing racism, discrimination, and a host of other systemic and structural issues also continue to heighten barriers for Native people in times of crisis. With little data to confirm these causal relationships, more research is desperately needed.
As states deploy newly approved vaccines and others in the pipeline come to market, IA2 supports calls for active efforts to promote “justice” and mitigation of health inequities, as proposed by the National Academies of Medicine.
However, justice in health for Native people must go beyond vaccine distribution. The Federal government must enhance efforts and live up to its responsibility to provide support, basic supplies, and funding for tribal healthcare workers and tribal health systems, urban Indian health organizations, communities, and other organizations serving AI/AN people.
Today, Native elders and communities continue to need food, clean water supplies, sanitation systems, attention to their mental and behavioral health needs, as well as the community, public health, and medical support necessary to survive this pandemic.
Healthcare providers and systems serving Native people need funding, support, and priority in local, state, and federal resource allocation to ensure they have the supplies and staff to safely and adequately serve their communities. Tribal and urban health systems need enhancements for failing or inadequate facilities, staffing support for overburdened and “at capacity” facilities or for those who have had to reduce capacity due to staff shortages, programs to address the impending mental health crisis among frontline healthcare workers, as well as an immediate fix for the myriad of long-standing un-addressed issues related to COVID-19 testing.
Funding and support for contract tracing, vaccine distribution programs, and other public health priorities related to COVID-19 must recognize and be scaled to address the inherent logistical and geographic challenges of many rural tribal and Alaskan village communities and scarce access to services and support for urban Indians.
Native people will continue to battle COVID-19 and other critical health and social issues daily, even after vaccine deployment begins.
Native elders, their children, and their families, as resilient people, will overcome this crisis. Collectively, we must then turn our attention to the decades-long issues that have plagued Native communities and people. Ten years from now– when we find ourselves again facing another pandemic or disaster– we don’t want to be left pointing to inadequate data or research that again documents the ongoing disproportionate burden of death and disease because we have failed Native people yet again.
To read the original study:
Arrazola J, Masiello MM, Joshi S, et al. COVID-19 Mortality Among American Indian and Alaska Native Persons — 14 States, January–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1853–1856.
The International Association for Indigenous Aging (IA2) is dedicated to improving the health and well-being of American Indians, Alaska Natives, and other Native people as they move through the aging spectrum. IA2 works to identify and implement effective solutions to the most significant issues facing tribal elders and their communities. Our work helps people and programs figure out how to competently and effectively engage and serve Native communities. We attempt to advance both knowledge and practice and promote engagement at all levels– local, tribal, regional, and national. Fundamentally, our work acknowledges the history, rights, cultures, and values of indigenous people throughout their lifespans, recognition of tribal sovereignty, and centering the work of Native communities in meaningful partnerships.