Follow the Evidence: Data Shows that American Indians and Alaska Natives are Disproportionately Impacted by COVID-19

By Ed Fox, PhD, Director of Tribal Data Project, National Indian Health Board and Dominique Covelli, MPM, Program Analyst, National Indian Health Board

It is evident that COVID-19 disease poses a greater threat to American Indians and Alaska Natives (AI/AN) for a myriad of health and socioeconomic factors, including poverty, housing, congregate living practices, and underlying chronic diseases such as Type 2 diabetes and COPD. The high rates of diabetes, asthma, and other diseases combined with poor living conditions and limited access to healthy foods make AI/ANs a vulnerable population for COVID-19 infection and death. Evidence shows that AI/ANs are disproportionately impacted by COVID-19.

The National Indian Health Board‘s (NIHB) analysis of state reports found that in states with Tribal populations, AI/ANs have the highest infection rates, including:

  • New Mexico – AI/ANs make up 43% of cases, but only 10% of the population
  • Arizona – 15% of COVID-related deaths and 5.5% of the population
  • Wyoming – 20% of cases and 3.7% of the population
  • South Dakota – 15% of the cases and 10% of the population
  • Montana – 11% of the cases and 8% of the population
  • Mississippi – 4.5% of the cases and less than 1% of the population

Racial misclassification and other factors make disease surveillance more difficult for Tribal populations, so it is advised to use caution when examining reports of disease prevalence and deaths for AI/ANs. Since the main direction of the reporting bias is to under-report disease and death, it is possible that greater dis-proportionality exists. In fact, there is not much reporting on race, and AI/ANs are often left off the list of options in demographic questionnaires.

Despite the evidence of disproportionality, in California, Oregon, Oklahoma, and Washington, the data shows AI/ANs have fared as well or better than the general population. Perhaps spurred by prompt crisis planning or lessons learned from the Navajo Nation’s experience with high spikes in positive cases and consecutive days of multiple deaths, Tribes quickly developed a response proportionate to the need. Given the determinants of health, and by extension the determinants of COVID-19 disease, Tribes essentially learned from each other on how to respond to the public health crisis by immediately declaring emergencies, urging Tribal members to stay home, and closing casinos and other enterprises to protect their workforce.

While it remains to be seen, after epidemiologists have time to examine the data for validity and reliability, if AI/ANs will escape the dire early predictions. There is hope that communities will fare well if they keep up the vigilance displayed so far. Currently, the Navajo Nation has nearly 9,000 confirmed positive cases and over 400 deaths, and it also has one of the most stringent public health orders including weekend lock-downs, nightly curfews and mandatory face coverings in all businesses.

The data will fluctuate and NIHB will continue to monitor and share it with Tribal leaders, advocates, and lawmakers to help bring needed resources and funding to Tribal Nations across the country. NIHB encourages Tribes to keep track and record data on their patients who are positive for COVID-19. Having the ability to do surveillance can be a game changer.

Visit the NIHB COVID-19 Tribal Resource Center to find state and Tribal data as well as community health and advocacy tools, fact sheets and information on federal agency and Tribal response plans.