Grossman DC, Krieger J, et al. Health status of urban American Indians and Alaska natives: a population-based study. Journal of the American Medical Association. 1994;271:845.
The authors used vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (AI/AN) population and compare it with urban whites and African Americans and with AI/ANs living on or near rural reservations in Washington state. The outcome measures used were low birthweight, infant mortality, and prevalence of risk factors for poor birth outcomes; age-specific and cause-specific mortality; and rates of several specific diseases.
The authors concluded that there were great disparities between the health of AI/ANs and that of whites across almost every health dimension they measured, but there were no consistent patterns in the comparison of health indicators between urban and rural AI/ANs. In terms of infant health, the researchers found that urban AI/ANs had a much higher rate of low birthweight than did urban whites or rural AI/ANs, and that rural AI/ANs had a much higher rate of infant mortality than did urban whites. Even though rural AI/ANs appeared to be the most disadvantaged group in the study in terms of socioeconomic characteristics, they were more likely than were urban AI/AN mothers to initiate prenatal care in the first trimester. This pattern may reflect the availability of comprehensive maternal and child health services offered by the Indian Health Service. The prevalence of low birthweight was higher among urban AI/ANs than it was among urban whites or rural AI/ANs, although it was lower than the prevalence of low birthweight among urban African Americans. During the 10 years from 1981 through 1990, urban AI/AN infant mortality rates rose from 9.6 per 1,000 live births to 18.6 per 1,000 live births, with no similar trend among the other populations. The authors recommend that federal, state, and local health authorities devote additional attention to improving the health status of urban AI/AN populations.
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