Death Rates From Human Immunodeficiency Virus and Tuberculosis Among American Indians/Alaska Natives in the United States, 1990–2009

Abstract

Objectives. We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. Methods. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100 000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Results. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). Conclusions. The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations.

Assessing New Diagnoses of HIV Among American Indian/Alaska Natives Served by the Indian Health Service, 2005-2014

“…IHS data do not implicate late diagnosis as a contributing factor and may point to a need for research assessing other possible factors that contribute to this disparity, such as access to care or adherence to treatment. 13 Whether certain trends, such as relatively high rates of new HIV diagnoses in the Southwest compared with other regions, indicate increased case finding through screening or elevated incidence is unclear. According to internal IHS data, IHS facilities in the Southwest region have the highest HIV screening coverage among those aged 13-64 nationwide, which may increase the detection of previously undiagnosed HIV.…”

“…IHS data do not implicate late diagnosis as a contributing factor and may point to a need for research assessing other possible factors that contribute to this disparity, such as access to care or adherence to treatment. 13…”

Tuberculosis morbidity at Haskell Institute, a Native American Youth Boarding School 1910–1940:∧

“…Native Americans continue to contract TB at higher rates than other racial groups in the United States (Reilley et al. ), and this inequality in infection rate can be attributed to many of the same causal factors that impacted Native American youth at Haskell Institute in the early 20 th century.…”

“…ࢳ Native Americans have traditionally exhibited higher rates of TB than white Americans (Young 1996). Native Americans continue to contract TB at higher rates than other racial groups in the United States (Reilley et al 2014), and this inequality in infection rate can be attributed to many of the same causal factors that impacted Native American youth at Haskell Institute in the early 20 th century. Historically, high rates of TB among Native Americans were explained through racial susceptibility (Hrdlička 1909;Reifel 1949;National Tuberculosis Association 1923).…”

Implementation of National HIV Screening Recommendations in the Indian Health Service

“…American Indian/Alaska Native (AI/AN) patients have among the fastest progression of AIDS diagnosis to death of any race/ethnicity. 1 In addition, this population has a significantly elevated death rate due to HIV/AIDS compared to whites, 2 making early detection of HIV and linkage to care a priority.…”