American Indian, Alaska Native Patients More Likely to Die in Hospital From COVID

The cross-sectional study looked at 18,731 adults hospitalized with COVID in 2020.

A recent study on in-hospital mortality rates among COVID-19 patients has found that American Indian and Alaska Native patients are more likely to die than patients of other races afflicted with COVID-19.

Issues with misclassifications and missing data related to the nation's data on indigenous populations have been brought to light over the duration of the pandemic, a Jama Network Open analysis found. For example, the Center for Disease Control and Prevention's (CDC) first report to include the COVID-19's impact on indigenous populations came five months into the pandemic, with information from only 23 states.

The high mortality rate is attributed to the high prevalence of comorbidities – the presence of two or more diseases or medical conditions in an individual – among Indigenous populations. The study was conducted in collaboration with the Mississippi State Department of Health, using the state's hospital discharge data repository.

COVID-19 spread rapidly throughout the state's band of Choctaw Indians, the only federally recognized tribe in the state, with 1 in 10 of its 10,000 members getting infected within the first six months. By comparison, 1 in 50 state residents were infected during the same period. While indigenous individuals make up 1% of the state's overall population, they accounted for 4.5% of the state's COVID-19 deaths as of July 2020.

"Although increased comorbidity risk was associated with in-hospital death, mortality was not uniformly observed across races at any risk level," the article accompanying the survey said. "Racial disparities exist such that American Indian and Alaska Native adults with COVID-19 had longer hospital stays and were significantly more likely than Black or White adults to die while in the hospital, despite a lower mean comorbidity risk burden."

While not discrediting the role comorbidities played in the mortality data, the article noted "discrimination, marginalization, inability to see preferred clinicians, and system underfunding of the Indian Health Service (HIS)" as contributing factors.

"If these barriers are overcome, indigenous persons still receive worse care than white individuals for an estimated 40% of quality measures," the article said. "The COVID-19 pandemic has further exposed these disparities."