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. 2020 Jul/Aug;26(4):371-377.
doi: 10.1097/PHH.0000000000001206.

American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic

Desi Rodriguez-Lonebear  1 , Nicolás E Barceló, Randall Akee, Stephanie Russo Carroll
Affiliations

American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic

Desi Rodriguez-Lonebear et al. J Public Health Manag Pract. 2020 Jul/Aug.

Erratum in

Abstract

Objective: To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states.

Design: Multivariate analysis with population weights.

Setting: Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands.

Main outcome measures: The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records.

Results: By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (-2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (-6.40, P = .326).

Conclusions: Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Unal D. Sovereignty and social justice: how the concepts affect federal American Indian policy and American Indian health. Soc Work Public Health. 2018;33(4):259–270. - PubMed
    1. Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. Just Societies: Health Equity and Dignified Lives. Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. Washington, DC: Pan American Health Organization of the World Health Organization; 2019. http://iris.paho.org/xmlui/handle/123456789/51571. Accessed April 10, 2020.
    1. Jones DS. The persistence of American Indian health disparities. Am J Public Health. 2006;96(12):2122–2134. - PMC - PubMed
    1. Indian Health Services. Indian health disparities. https://www.ihs.gov/newsroom/factsheets/disparities. Published 2019. Accessed April 10, 2020.
    1. Commission on the Social Determinants of Health. Social determinants and indigenous health: the international experience and its policy implications. Paper presented at: International Symposium on the Social Determinants of Indigenous Health; 2007; Adelaide, Australia.

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